Grant: Operating Grant: SPOR Innovative Clinical Trial Multi-Year Grant

Rates of infectious syphilis, and most alarmingly cases of congenital syphilis, are reaching crisis proportions in Canada, particularly in the prairie provinces of Alberta (AB), Manitoba (MB), and Saskatchewan (SK) - and affecting principally Indigenous people. According to the Public Health Agency of Canada, the national rate of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 30 per 100,000 population in 2021 with the Prairie provinces reporting the greatest relative increases from 2017 to 2021 (more than 400% in AB and MB, and 1346% in SK). Moreover, confirmed early congenital syphilis cases in Canada have been increasing considerably from prior years, with 50 cases reported in 2020 and 96 cases in 2021, compared with 7 cases in 2017. The consequences of congenital syphilis for mother and unborn infant can be severe, resulting in miscarriage, stillbirth, prematurity, low birth weight and death shortly after birth. For babies born with congenital syphilis, this can cause deformed bones, severe anemia, enlarged liver and spleen, jaundice, neurological problems (blindness and/or deafness), meningitis and skin rashes. Without rapid actions to facilitate low barrier access to rapid syphilis testing, treatment and care, it will be impossible to turn this tide of rising infectious and congenital syphilis rates. Our intervention programs for syphilis and HIV in Alberta demonstrated the clinical utility of this intervention approach for reaching the undiagnosed living with syphilis and/or HIV and linking them to treatment and care. We have assembled teams in AB, SK and MB who will adapt and implement versions of the PoSH study (specifically for their contexts) to reach 10,000 people who are undiagnosed and are living with syphilis and/or HIV in those provinces and connect them with opportunities for them to receive immediate treatment for syphilis, and culturally appropriate care and treatment for syphilis and HIV.