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The intervention includes standing orders for syphilis serological testing whenever a male in HIV care undergoes HIV viral load testing, which typically occurs every 3–6 months.
The control condition is the maintenance of current, provider-initiated syphilis testing practice.
Involvement of knowledge users in all stages of trial design, conduct, and analysis will facilitate scale-up should the intervention be effective.].
In Ontario, lifetime syphilis prevalence among MSM in HIV care was estimated to be 23.4 % as of 2009, and in 2010, incidence of a new syphilis diagnosis was 4.3 per 100 person-years (PY), over 300 times greater than the rate of 0.01 per 100 PY reported for the general male population .
Compared to a 12-month pre-intervention period, this intervention led to an increase from 3 to 85 % of patients receiving at least one syphilis test, a reduction in the median time between syphilis tests from 6 to 4 months, and a 27 % increase in the number of early syphilis cases detected during the 12-month intervention period .
The current syphilis epidemic among urban men who have sex with men (MSM) has serious implications for those co-infected with human immunodeficiency virus (HIV).Trial objectives are to determine the degree to which the intervention (1) increases the detection rate of untreated syphilis, (2) increases screening coverage, (3) increases screening frequency, and (4) reaches men at highest risk according to sexual behaviors.The trial is a pragmatic, stepped wedge cluster-randomized controlled trial that introduces the intervention stepwise across four urban HIV clinics in Ontario, Canada.Approximately 3100 HIV-positive men will be followed over 30 months.Test results will be obtained from the centralized provincial laboratory in Ontario and will be supplemented by a standardized clinical worksheet and medical chart review at the clinics.
Health economic components include evaluation of the impact and cost-effectiveness of the intervention.