Grant: Travel Awards - Institute Community Support

BACKGROUND: Public health units (PHUs) in Canada have experienced significant increases in cases of infectious syphilis. The Kingston, Frontenac and Lennox & Addington (KFL&A) PHU declared an outbreak in December 2022, with underserved populations, such as those experiencing homelessness or using drugs, disproportionately affected. In 2023, KFL&A PHU implemented an "outreach rapid test and immediate treatment model," where PHU employees visit locations underserved populations are known to frequent, providing a dual HIV/Syphilis point of care test (POCT). The POCT delivers results in five minutes, enabling immediate syphilis treatment for positive cases, with additional blood drawn for lab diagnostics. This model has shown promise in identifying undiagnosed cases, in turn influencing long-term reduction of new syphilis cases, highlighting its potential utility to other PHUs/regions. To our knowledge, assessing the facilitators behind adopting this model of care represents the first study of its kind in Canada. METHODS: A qualitative case study examined the decision-making process in a small-urban/rural PHU. Six interviews with front-line and decision-making staff at KFL&A PHU and 20 internal reports were analyzed to generate results. RESULTS: Key facilitators included infrastructure supporting implementation (e.g., COVID-19 outreach models, community-based organization partnerships, nurses practicing to their full scope), the intervention's relevance (e.g., reducing syphilis incidence, outbreak urgency, addressing congenital cases), cost-effectiveness (e.g., fully-funded initial testing), an accurate, sensitive test, and innovation drivers across decision-making levels. CONCLUSIONS: These insights provide actionable guidance for PHUs aiming to adopt and scale similar interventions efficiently to tackle syphilis in their communities. Thus, aiding the critical public health challenge of surging infectious syphilis cases.