Tandem Testing: Integrating Point-of-Care Syphilis within HIV Testing Programs at CBOs

Background:  In Virginia, the burden of coinfection of HIV and syphilis is significant, with approximately one third of early syphilis being diagnosed among HIV positive patients. This creates an opportunity to strengthen collaboration and integrate service provision. VDH 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 local health department (LHD) clinics.

Methods:  CBOs were identified for participation based on the following criteria: current participation as a POC HIV testing site, local syphilis morbidity, geographic catchment, rapport with at-risk population, lack of clinical capacity, and sufficient adherence to HIV-related quality control standards. State/LHD/pilot CBO staff collaborated to develop a business process flow and data collection tool to capture demographic and risk behaviors for those tested. Individuals with a positive result were referred to the LHD. The Plan-Do-Study-Act (PDSA) model for quality improvement was used following program implementation. 

Results:  Among the 62 positives identified between November 2015 and March 2016 (420 total tests; 15% positivity), 55% were non-Hispanic black, 61% male, and 44% MSM. Specificity of the test was 94%, the positive predictive value (PPV) was 57%, and false positivity (FP) was 29%. Inclusion of syphilis testing resulted in a 13% increase in the average cost per test when integrated with HIV at ten CBOs. The PDSA and qualitative evaluation of CBO staff identified three primary areas for improvement.

Conclusions:  Integration of syphilis testing within the existing HIV POC testing program offers many advantages in maximizing opportunities to diagnose, treat, and prevent infection. Reflecting a FP of nearly one in three, subsequent treponemal/non-treponemal serologic tests are essential. Additional POC tests in development will further expand the reach of screening outside of clinical environments necessitating a unified approach to collaboration and service integration.