Stopping syphilis transmission in Arctic communities through rapid diagnostic testing: The STAR study protocol

Intense transmission of syphilis has emerged in some Canadian Arctic communities despite screening and prevention efforts. The remoteness of most communities and limited diagnostic infrastructure yield long delays ([greater than or equal to]14 days) between screening and treatment of cases. These ha...

Full description

Saved in:
Bibliographic Details
Published in:PloS one Vol. 17; no. 9; p. e0273713
Main Authors: Caya, Chelsea, Maheu-Giroux, Mathieu, Xia, Yiqing, Serhir, Bouchra, Morin, Veronique, Libman, Michael, Corsini, Rachel, Goldfarb, David M., Wong, Tom, Singh, Ameeta E., Yansouni, Cedric P.
Format: Journal Article
Language:English
Published: San Francisco Public Library of Science 12.09.2022
Subjects:
Accuracy
Algorithms
Arctic zone
Biology and Life Sciences
Blood
Congenital diseases
Control
Decision making
Diagnostic systems
Diagnostic tests
Disease control
Disease transmission
Epidemiology
Ice environments
Informed consent
Laboratories
Medical diagnosis
Medical tests
Medicine and Health Sciences
Methods
Outbreaks
People and places
Polar environments
Prevention
Public health
Research and Analysis Methods
Sexual health
Sexually transmitted diseases
STD
Study Protocol
Syphilis
Arctic
Nunavik Quebec Canada
Canada
Nunavut Territory Canada
Arctic region
Quebec Canada
ISSN:1932-6203, 1932-6203
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Intense transmission of syphilis has emerged in some Canadian Arctic communities despite screening and prevention efforts. The remoteness of most communities and limited diagnostic infrastructure yield long delays ([greater than or equal to]14 days) between screening and treatment of cases. These hamper syphilis control efforts and may contribute to sustained transmission. Syphilis rapid diagnostic tests (RDTs) have been developed to make screening more accessible and to inform clinical decision-making within the same clinical encounter. These RDTs have been successfully deployed in several countries, but not yet in Canada. We describe the methodology of the "Stopping Syphilis Transmission in Arctic Communities Through Rapid Diagnostic Testing" (STAR) study, wherein the clinical and epidemiological impact of deploying a dual syphilis RDT in the context of ongoing transmission in Nunavut and Nunavik will be evaluated. In this prospective multisite field evaluation, sexually active individuals aged [greater than or equal to]14 years at risk for syphilis will be offered screening by an RDT at the point-of-care by non-laboratory trained registered nurses. Whole blood and serum specimens will be concurrently collected, when feasible, for rapid testing with an RDT containing both treponemal and non-treponemal components (Chembio DPP.sup.® Syphilis Screen & Confirm) and compared to laboratory-based reference testing according to a reverse sequence algorithm. The diagnostic accuracy of the RDT, using both whole blood and centrifuged serum specimens, will be validated under real-world conditions in remote Northern settings, outside of specialized laboratories. Additionally, screening-to-treatment time, case detection rates, and the number of infectious contacts averted by using the RDT relative to reference testing will be estimated. The impact of both diagnostic approaches on syphilis transmission dynamics will also be modeled. This study will provide much needed evidence for strengthening rapid responses to emerging syphilis outbreaks in remote Arctic regions, by supplementing traditional diagnostic strategies with an RDT to rapidly triage patients likely in need of treatment. These results will also inform the development and tailoring of future diagnostic strategies and public health responses to emerging outbreaks in the North.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: CPY reports being on an Independent Data Monitoring Committee (IDMC) for Medicago Inc. MM-G reports an investigator-sponsored research grant from Gilead Sciences Inc., and contractual arrangements from the Institut national de santé publique du Québec (INSPQ), the Institut d’excellence en santé et services sociaux (INESSS), the World Health Organization, and the Joint United Nations Programme on HIV/AIDS (UNAIDS), all outside of the submitted work. All other authors report no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0273713