Syphilis rates are increasing rapidly in Canada. One reason for the spike in infections is the delays in testing and treatment. It's especially important to address these issues for people who are homeless, in unstable housing, or using drugs because their social and economic challenges make them more likely to get infected and harder for them to get tested and treated on time. We need to make sure it's effectively used in real-life situations. One way to reach more undiagnosed people is by using these rapid tests outside healthcare settings. But there haven't been many studies on how well this approach works. The Kingston, Frontenac, Lennox & Addington Public Health Unit (KFL&APH) is taking the lead by implementing a rapid test and treat program targeting underserved communities.

 

Our research proposal has three main objectives.

1. To identify the things that make it easier or harder for decision-makers and implementers to use rapid testing and treatment programs.

2. To evaluate how effectively these programs reduce syphilis rates.

3. To estimate the long-term impact of these programs on reducing syphilis cases using mathematical models.

This collaboration has the potential to generate valuable insights, tools, and knowledge that will benefit public health in the long run.

Congenital syphilis is increasing rapidly across Canada. This is when babies are born with syphilis infections because their mothers were infected during pregnancy, Early diagnosis and treatment in pregnant women can stop them from passing syphilis to their babies.

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Our study will investigate how well prenatal syphilis screening is followed across all public health units in Ontario. Next, we'll use the differences in recommendations between these units to see if increasing testing for all women is better at reaching those at the highest risk of syphilis compared to only testing based on risk factors. We will do this by using health administrative data and forming a new team with experts in public health, infectious diseases, and maternal and perinatal health. Our existing collaborations with public health units across Ontario will facilitate the timely completion of our research and allow our work to be implemented into practice. Overall, our research has the potential to evaluate equitable access to prenatal screening, which can ultimately reduce congenital syphilis and lay the groundwork for future syphilis research in Canada.

      

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Smartphones have become an essential part of our daily lives. The unprecedented number of people with access to smartphones has created an opportunity to amass and track population-level mobility patterns through Global Positioning Systems (GPS). When smartphone users download certain application (i.e. weather, navigation or social media) they allow the applications to track and record their locations. The magnitude and value of these analytics are not lost by commercial companies who buy these data, mostly for targeted advertising purposes. The COVID-19 pandemic exposed the capacity of using mobility data as an epidemiological surveillance tool to support public health decision-making.

 

Here we propose expanding on our mobility research which uses aggregated location data collected by smartphones via GPS as a means to evaluate adherence to policies, and identify disparities and the impact of the COVID-19 pandemic at long-term care facilities and hospitals. We have put together a team that brings together expertise in epidemiology, biostatistics, geriatrics, and geospatial analytics using big data to provide new insights on how to optimally leverage anonymous mobility data that can continue to inform public health decision making post-pandemic.

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Our community-centred implementation science research aims to improve the administration of point-of-care tests (POCT) and treatment to targeted underserved populations in non-urban communities experiencing some of the highest infectious syphilis rates in Ontario. Concurrently, we seek to address the rise in infectious syphilis cases by pairing POCT and treatment with existing public health outreach programs and to understand the community's preferences to maximize equitable access and adoption of POCTs in the future. Specific objectives include:

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O1: Expand and evaluate our pilot “POCT test and treat” model of care for underserved populations using the RE-AIM framework. We will expand our successful pilot to additional PHUs in Northern Ontario.
O2: Elicit the preferences for syphilis testing and treatment by conducting a discrete choice experiment from geographically diverse groups of underserved populations.
O3: Accelerate knowledge mobilization (KM) by creating a real-time exchange of information between community organizations, PHUs, and other relevant knowledge users to support decision-making.

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is caused by fat accumulating in the liver over time, causing inflammation and scarring. An estimated 1 in 4 Canadians has MASLD, but very few are aware. People with type 2 diabetes are at a high risk of advanced disease progression, making them an ideal population for screening. International experts recommend using a simple test called the Fibrosis-4 index (FIB-4) to screen for advanced liver fibrosis in high-risk groups like people with diabetes. However, there are currently no Canadian Diabetes guidelines for screening for fibrosis. And access to the necessary blood tests to calculate FIB-4 is not currently universally available.

 

We propose to describe the variability in screening strategies (different blood tests) and rates over time. We will then identify factors and subgroups of people with distinct screening patterns and examine how these patterns are associated with liver disease progression. Finally, we will evaluate which screening strategy is the most cost-effective. We will use data routinely collected from health records and advanced statistical methods to account for many of the biases found when using this type of data. Ultimately, the goal is to develop effective and equitable screening strategies to prevent liver disease progression in people with diabetes.