The Syphilis Point of Care Rapid Testing and Immediate Treatment Evaluation (SPRITE) Study

ABSTRACT Background In the last decade, the rates of infectious syphilis have increased by 505% in Ontario, Canada. Underserved populations–people who use drugs, un(der)housed individuals, and those living in rural and remote areas - face unique social and healthcare challenges that increase their vulnerability to syphilis infections and hinder their access to timely diagnosis and treatment. Given the shift in epidemiology and the geographic disparities in resources, there is no one-size-fits-all solution to this complex issue. Access to low-barrier diagnostics, such as point-of-care (POC) tests for HIV and hepatitis C, has been shown to be an effective strategy for reaching underserved people outside of traditional healthcare settings. However, there is a paucity of evidence regarding the effectiveness of POC tests for other sexually transmitted and blood-borne infections, particularly in non-urban, rural, and remote settings. Methods/Design The Syphilis Rapid Point-of-Care Testing and Immediate Treatment Evaluation (SPRITE) Study includes nine Public Health Units (PHUs) in Ontario. The INSTI® Multiplex HIV-1/HIV-2/Syphilis Antibody Test will be used to evaluate a “rapid test and immediate treatment” outreach model of care targeting people who are un(der)housed or who use drugs at multiple community-based settings anchored to their respective PHU. Implementation of the model of care will be evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, following a community-based participatory approach. Empirical results will inform network models to estimate the population-level impact of using POC test to curb transmission. Discussion Urgent, tailored, and equitable action is needed to address the alarming rise in syphilis rates in Canada. This study assesses the real-world effectiveness of syphilis POC tests in breaking barriers and bringing services to the population at the highest risk. Results will inform future implementation, build capacity, and provide the evidence necessary for program decision-making. STRENGTHS AND LIMITATIONS OF THIS STUDY This study employs a comprehensive evaluation framework, utilizing various approaches and tools encompassing quantitative and qualitative methods to address our research questions. This multiplicity enables enhanced triangulation of research findings. Including various public health units addresses a gap in research by acknowledging and investigating the unique challenges faced by underserved communities living in diverse non-urban, rural, and remote settings. Leveraging academic, public health, and community partnerships enhances this study’s potential for real-world impact by incorporating diverse perspectives, expertise, and collaborative efforts.