Grant: Health System Impact Fellowships - Doctoral Central Canada 1-year

Ontario continues to experience an ongoing crisis due to infectious syphilis with a 505% increase in cases between 2013 and 2022. Timely treatment can be accomplished with a single penicillin injection, preventing severe complications and further transmission. Unfortunately, there are barriers to early infection control including individuals not getting tested or not returning for their results. Addressing these barriers is especially critical for underserved populations, including individuals who are un(der)housed and/or use substances as they are known to be disproportionately affected by syphilis. Since June 2023, Kingston Frontenac Lennox & Addington Public Health Unit has deployed outreach events that pair rapid point-of-care tests (POCTs), which identify syphilis and HIV infections in as little as 60 seconds, with immediate treatment in collaboration with local organizations serving underserved communities. In September 2023, four other Ontario public health units began emulating this intervention. This project's primary goal is to assess the barriers and facilitators to implementing the 'POCT and treat' model of care for underserved populations in Ontario. It will involve interviews and focus groups with 20-30 individuals from both members of underserved populations and individuals involved in implementing the intervention (e.g. nurses, public-health and community-based decision makers). The interviews and focus groups will explore program utilization and implementation. Transcripts with be systematically analyzed for recurring themes, which will in turn support program and policy recommendations. In the fight against the growing syphilis rates, allocating resources toward interventions that work is vital. While 'POCT and treat' interventions represent a low-barrier method to interrupt transmission and provide treatment, evidence is needed to inform improvements for future implementation, and build capacity for other public health units.