{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:02:28Z","timestamp":1791975748655,"version":"4.4.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100027448","name":"Catalyst","doi-asserted-by":"publisher","award":["SR8 190795"],"award-info":[{"award-number":["SR8 190795"]}],"id":[{"id":"10.13039\/100027448","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Operating","award":["AS1-192619"],"award-info":[{"award-number":["AS1-192619"]}]},{"name":"Knowledge Mobilization","award":["EKS 193138"],"award-info":[{"award-number":["EKS 193138"]}]},{"name":"NPA SS"},{"name":"NPA MC"},{"name":"Public Health Ontario"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Syphilis has reemerged as a global public health concern. In Ontario, Canada's most populous province, a 340% increase in infectious syphilis cases was observed between 2013 and 2023. This surge was accompanied by a demographic shift, with women emerging as the fastest-growing at-risk group. We examined intersecting risk factors associated with syphilis seropositivity among a street-involved population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data were collected from the Syphilis Point of Care Rapid Test and Immediate Treatment Evaluation (SPRITE) study\u2014an outreach model of care implemented by 8 public health units (PHUs) across Ontario between 2023 and 2024. Reactive treponemal antibodies defined syphilis seroprevalence. A mixed-effects regression with a log-binomial distribution was used to evaluate the association between risk factors and seropositivity. Adjusted prevalence ratio (aPR) controlled for age and sex and clustering by PHUs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 630 participants, 42% women, with a median age of 38, were included; 19.1% of participants reported having sexual risk factors, using illicit drugs, and being un(der)housed. Overall, syphilis seroprevalence was 7.6% (95% confidence interval 5.5\u20139.7), with significant heterogeneity across the province and higher among those reporting 3 risk factors (19.2% [11.2\u201329.7]) compared with 1 risk factor (4.8% [1.8\u201310.1]). Seropositivity was higher among women (aPR 1.62 [.94\u20132.80]) and people who use illicit drugs (aPR 2.30 [.93\u20135.50]), particularly those who use crystal methamphetamine (aPR 2.88 [1.31\u20136.33]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Syphilis is heightened at the intersection of sexual risk factors, illicit drug use, and housing instability among equity-deserving populations. Targeted outreach models of care are necessary to reach this emerging at-risk population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf472","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T20:01:02Z","timestamp":1755028862000},"source":"Crossref","is-referenced-by-count":5,"title":["Intersecting Risk Factors Associated With High Syphilis Seroprevalence Among a Street-Involved Population in Canada"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0097-0811","authenticated-orcid":false,"given":"Lucy","family":"Mackrell","sequence":"first","affiliation":[{"name":"Queen's University , Kingston ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1067-5124","authenticated-orcid":false,"given":"Jillian P","family":"Antoun","sequence":"additional","affiliation":[{"name":"Queen's University , Kingston 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