Abstract:
BACKGROUND: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). Routine and frequent syphilis screening has the potential to ensure early detection and treatment, minimize disease burden, and help control the ongoing spread of syphilis and HIV. We aim to enhance syphilis screening among HIV-positive men by conducting a clinic-based intervention that incorporates opt-out syphilis testing into routine HIV laboratory evaluation for this population. 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. METHODS/DESIGN:The trial is a pragmatic, stepped wedge cluster-randomized controlled trial that introduces the intervention stepwise across four urban HIV clinics in Ontario, Canada. 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. 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. Detailed clinical, psychosocial, and behavioral data is available for a subset of men receiving HIV care who are also participants of the province-wide Ontario HIV Treatment Network Cohort Study. Process evaluation plans include audit and feedback of compliance of the participating centers to identify potential barriers to the introduction of this type of practice into routine care. Health economic components include evaluation of the impact and cost-effectiveness of the intervention. DISCUSSION:This trial will be the first of its kind in Canada and will provide evidence regarding the feasibility, clinical effectiveness, and cost-effectiveness of a clinic-based intervention to improve syphilis screening among HIV-positive men. Involvement of knowledge users in all stages of trial design, conduct, and analysis will facilitate scale-up should the intervention be effective. TRIAL REGISTRATION:ClinicalTrials.gov NCT02019043.
journal_name
Implement Scijournal_title
Implementation science : ISauthors
Burchell AN,Allen VG,Grewal R,MacPherson PA,Rachlis A,Walmsley S,Mishra S,Gardner SL,Raboud J,Cooper C,Gough K,Rourke SB,Rousseau R,Salit I,Tan DHdoi
10.1186/s13012-016-0371-0subject
Has Abstractpub_date
2016-01-16 00:00:00pages
8issn
1748-5908pii
10.1186/s13012-016-0371-0journal_volume
11pub_type
杂志文章abstract:BACKGROUND:The continuing gap between available evidence and current practice in health care reinforces the need for more effective solutions, in particular related to organizational context. Considerable advances have been made within the U.S. Veterans Health Administration (VA) in systematically implementing evidence...
journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2008-05-29 00:00:00
abstract:BACKGROUND:Substance misuse is now encountered in settings beyond addiction specialty care, with schools a point-of-contact for student access to behavioral health services. Marijuana is a leading impetus for adolescent treatment admissions despite declining risk perception, for which the Teen Marijuana Check-Up (TMCU)...
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journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究
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abstract:BACKGROUND:Despite the potential to reach at-risk children in childcare, there is a significant gap between current practices and evidence-based obesity prevention in this setting. There are few investigations of the impact of implementation strategies on the uptake of evidence-based practices (EBPs) for obesity preven...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2017-07-18 00:00:00
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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更新日期:2019-06-18 00:00:00
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journal_title:Implementation science : IS
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