Ann N Burchell1,2,3, Darrell H S Tan2,4,5,6, Ramandip Grewal2, Paul A MacPherson7,8,9, Sharon Walmsley4,10, Anita Rachlis4,11, Nisha Andany4,11, Sharmistha Mishra2,4,12, Sandra L Gardner13,14, Janet Raboud5,14, David Fisman14, Curtis Cooper8,15, Kevin Gough4,6, John Maxwell16, Sean B Rourke2,17, Rodney Rousseau18, Tony Mazzulli19,20, Irving E Salit10, Vanessa G Allen20. 1. Department of Family and Community Medicine, St Michael's Hospital, Unity Health, Toronto, Toronto, Ontario, Canada. 2. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada. 3. Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 5. Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. 6. Division of Infectious Diseases, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada. 7. Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada. 8. Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. 9. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 10. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. 11. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 12. Institute of Medical Science and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. 13. Baycrest, Toronto, Ontario, Canada. 14. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 15. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 16. ACT, Toronto, Ontario, Canada. 17. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 18. Department of Immunology, University of Toronto, Toronto, Ontario, Canada. 19. Mount Sinai Hospital, Toronto, Ontario, Canada. 20. Public Health Ontario Laboratories, Public Health Ontario, Toronto, Ontario, Canada.
Abstract
BACKGROUND: We implemented an opt-out clinic-based intervention pairing syphilis tests with routine human immunodeficiency virus (HIV) viral load testing. The primary objective was to determine the degree to which this intervention increased the detection of early syphilis. METHODS: The Enhanced Syphilis Screening Among HIV-Positive Men (ESSAHM) Trial was a stepped wedge cluster-randomized controlled trial involving 4 urban HIV clinics in Ontario, Canada, from 2015 to 2017. The population was HIV-positive adult males. The intervention was standing orders for syphilis serological testing with viral loads, and control was usual practice. We obtained test results via linkage with the centralized provincial laboratory and defined cases using a standardized clinical worksheet and medical record review. We employed a generalized linear mixed model with a logit link to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the intervention. RESULTS: A total of 3895 men were followed over 7471 person-years. The mean number of syphilis tests increased from 0.53 to 2.02 tests per person per year. There were 217 new diagnoses of syphilis (control, 81; intervention, 136), for which 147 (68%) were cases of early syphilis (control, 61 [75%]; intervention, 86 [63%]). The annualized proportion with newly detected early syphilis increased from 0.009 to 0.032 with implementation of the intervention; the corresponding time-adjusted OR was 1.25 (95% CI, .71-2.20). CONCLUSIONS: The implementation of standing orders for syphilis testing with HIV viral loads was feasible and increased testing, yet produced less-than-expected increases in case detection compared to past uncontrolled pre-post trials. CLINICAL TRIALS REGISTRATION: NCT02019043.
BACKGROUND: We implemented an opt-out clinic-based intervention pairing syphilis tests with routine human immunodeficiency virus (HIV) viral load testing. The primary objective was to determine the degree to which this intervention increased the detection of early syphilis. METHODS: The Enhanced Syphilis Screening Among HIV-Positive Men (ESSAHM) Trial was a stepped wedge cluster-randomized controlled trial involving 4 urban HIV clinics in Ontario, Canada, from 2015 to 2017. The population was HIV-positive adult males. The intervention was standing orders for syphilis serological testing with viral loads, and control was usual practice. We obtained test results via linkage with the centralized provincial laboratory and defined cases using a standardized clinical worksheet and medical record review. We employed a generalized linear mixed model with a logit link to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the intervention. RESULTS: A total of 3895 men were followed over 7471 person-years. The mean number of syphilis tests increased from 0.53 to 2.02 tests per person per year. There were 217 new diagnoses of syphilis (control, 81; intervention, 136), for which 147 (68%) were cases of early syphilis (control, 61 [75%]; intervention, 86 [63%]). The annualized proportion with newly detected early syphilis increased from 0.009 to 0.032 with implementation of the intervention; the corresponding time-adjusted OR was 1.25 (95% CI, .71-2.20). CONCLUSIONS: The implementation of standing orders for syphilis testing with HIV viral loads was feasible and increased testing, yet produced less-than-expected increases in case detection compared to past uncontrolled pre-post trials. CLINICAL TRIALS REGISTRATION: NCT02019043.
Authors: Jarvis W Carter; Geoffrey D Hart-Cooper; Mary O Butler; Kimberly A Workowski; Karen W Hoover Journal: Sex Transm Dis Date: 2014-02 Impact factor: 2.830
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Authors: Kinnon R MacKinnon; Ramandip Grewal; Darrell Hs Tan; Rodney Rousseau; John Maxwell; Sharon Walmsley; Paul A MacPherson; Anita Rachlis; Nisha Andany; Sharmistha Mishra; Vanessa G Allen; Ann N Burchell Journal: BMC Health Serv Res Date: 2021-06-30 Impact factor: 2.655
Authors: Ann N Burchell; Vanessa G Allen; Veronika Moravan; Sandra Gardner; Janet Raboud; Darrell H S Tan; Ahmed M Bayoumi; Rupert Kaul; Tony Mazzulli; Frank McGee; Peggy Millson; Robert S Remis; Sean B Rourke Journal: BMC Infect Dis Date: 2013-05-28 Impact factor: 3.090
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Authors: Ann N Burchell; Vanessa G Allen; Ramandip Grewal; Paul A MacPherson; Anita Rachlis; Sharon Walmsley; Sharmistha Mishra; Sandra L Gardner; Janet Raboud; Curtis Cooper; Kevin Gough; Sean B Rourke; Rodney Rousseau; Irving Salit; Darrell H S Tan Journal: Implement Sci Date: 2016-01-16 Impact factor: 7.327
Authors: Suraj Balakrishna; Luisa Salazar-Vizcaya; Axel J Schmidt; Viacheslav Kachalov; Katharina Kusejko; Maria Christine Thurnheer; Jan A Roth; Dunja Nicca; Matthias Cavassini; Manuel Battegay; Patrick Schmid; Enos Bernasconi; Huldrych F Günthard; Andri Rauch; Roger D Kouyos Journal: PLoS Comput Biol Date: 2021-10-26 Impact factor: 4.475