{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T05:17:25Z","timestamp":1785561445510,"version":"3.56.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,6,27]],"date-time":"2021-06-27T00:00:00Z","timestamp":1624752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["MOP 130440"],"award-info":[{"award-number":["MOP 130440"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CIHR Canadian HIV Trials Network","award":["CTN-275"],"award-info":[{"award-number":["CTN-275"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We implemented an opt-out clinic-based intervention pairing syphilis tests with routine human immunodeficiency virus (HIV) viral load testing. The primary objective was to determine the degree to which this intervention increased the detection of early syphilis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The Enhanced Syphilis Screening Among HIV-Positive Men (ESSAHM) Trial was a stepped wedge cluster-randomized controlled trial involving 4 urban HIV clinics in Ontario, Canada, from 2015 to 2017. The population was HIV-positive adult males. The intervention was standing orders for syphilis serological testing with viral loads, and control was usual practice. We obtained test results via linkage with the centralized provincial laboratory and defined cases using a standardized clinical worksheet and medical record review. We employed a generalized linear mixed model with a logit link to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the intervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 3895 men were followed over 7471 person-years. The mean number of syphilis tests increased from 0.53 to 2.02 tests per person per year. There were 217 new diagnoses of syphilis (control, 81; intervention, 136), for which 147 (68%) were cases of early syphilis (control, 61 [75%]; intervention, 86 [63%]). The annualized proportion with newly detected early syphilis increased from 0.009 to 0.032 with implementation of the intervention; the corresponding time-adjusted OR was 1.25 (95% CI, .71\u20132.20).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The implementation of standing orders for syphilis testing with HIV viral loads was feasible and increased testing, yet produced less-than-expected increases in case detection compared to past uncontrolled pre\u2013post trials.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trials Registration<\/jats:title>\n                  <jats:p>NCT02019043.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab582","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T03:16:10Z","timestamp":1624504570000},"page":"846-853","source":"Crossref","is-referenced-by-count":6,"title":["Routinized Syphilis Screening Among Men Living With Human Immunodeficiency Virus: A Stepped Wedge Cluster Randomized Controlled Trial"],"prefix":"10.1093","volume":"74","author":[{"given":"Ann N","family":"Burchell","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, St Michael\u2019s Hospital, Unity Health, Toronto, Toronto, Ontario, Canada"},{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"},{"name":"Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrell H S","family":"Tan","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"},{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada"},{"name":"Division of Infectious Diseases, St Michael\u2019s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramandip","family":"Grewal","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A","family":"MacPherson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada"},{"name":"Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada"},{"name":"Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Walmsley","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Toronto General Hospital, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Rachlis","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Andany","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, 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Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Raboud","sequence":"additional","affiliation":[{"name":"Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fisman","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis","family":"Cooper","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada"},{"name":"Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Gough","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Infectious Diseases, St Michael\u2019s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Maxwell","sequence":"additional","affiliation":[{"name":"ACT, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean B","family":"Rourke","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"},{"name":"Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, 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