Approximately one third of early syphilis diagnoses are among HIV positive patients in Virginia. Burden of coinfection between HIV and syphilis is significant, creating opportunities to strengthen collaboration and integrate service provision. The Virginia Department of Health supports a robust network of HIV screening sites including non-clinical settings administering point-of-care (POC) tests. Community based organizations (CBOs) in Virginia have historically reached a high-risk population not presenting in traditional clinics. In December 2014, a POC syphilis test received CLIA waiver, thereby enabling expansion of testing beyond traditional clinical settings. HIV and STD positivity vary significantly by testing venue; positivity and characteristics of patients presenting at CBOs for syphilis testing are unknown.
METHODS:
CBOs were identified for participation based on the following criteria: current participation as a POC HIV testing site, local syphilis morbidity, geographic catchment area, rapport with at-risk population, lack of clinical capacity, CBO interest, and sufficient adherence to HIV-related quality control standards. A pilot CBO was recruited and business process flow developed in collaboration with state/local health department (LHD) and CBO staff. A data collection tool captured demographic and risk behaviors of the tested population and a qualitative evaluation was conducted among CBO staff.
RESULTS:
Ten CBOs across Virginia were identified. The pilot CBO began testing in late November 2015 and the remaining nine will commence in late January 2016. Early results from the pilot yield a positivity of 43% among seven persons tested November to December 2015. The majority tested were non-Hispanic black (71%), male (100%), and report male to male sexual contact (MSM; 86%). Among positives, MSM (66%) and transactional sex (33%) were reported. Warm hand-offs to LHD Disease Intervention Specialists were accomplished for all positives. Initial program expenses were limited to test kits and lancets as no additional staff nor supplies, beyond those used for HIV testing, were necessary. A qualitative evaluation of staff identified two primary areas for improvement.
CONCLUSIONS:
Early results identified 43% positivity at a CBO with very low test volume. Statewide implementation is underway. Integration of syphilis testing within the existing HIV POC testing program offers many advantages in lowering total cost of service provision and maximizing opportunities to diagnose, treat, and prevent infection. Additional POC tests in development, which may acquire CLIA waiver, may further expand the reach of screening outside of clinical environments. Tandem HIV/syphilis POC testing may be on the horizon necessitating a unified approach to collaboration and service integration.