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Injection drug use is a major contributor to these syndemic infections, exacerbated by structural barriers such as stigma, poverty and limited culturally safe healthcare. Innovative, community-informed approaches are urgently needed to improve prevention, testing and linkage to care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This study will implement a rapid assessment and response system in Regina, Saskatchewan, Canada, integrating geospatial mapping of community needle prevalence with pop-up interventions. Needle hotspot maps will be used to guide the deployment of community-based pop-up events offering point-of-care testing for HIV, syphilis and HCV, alongside education on pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). A convergent participatory mixed-methods design will be used to evaluate feasibility, acceptability and effectiveness, guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Quantitative data will assess changes in knowledge of PrEP and PEP, satisfaction with the intervention and report new diagnoses and participant demographics descriptively. A qualitative substudy will include 30 participants and will explore experiences with the intervention, barriers to care and perceptions of service delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval has been obtained from the research ethics board of the Saskatchewan Health Authority (#24\u201391). Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. This study may provide a model of community-based geospatial testing and education that could be scaled up and adapted elsewhere.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>\n                      Open Science Framework\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.17605\/OSF.IO\/HVK3B\">https:\/\/doi.org\/10.17605\/OSF.IO\/HVK3B<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108691","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:57:14Z","timestamp":1762325834000},"page":"e108691","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Three infections, one fight: an implementation study to map needle prevalence and evaluate HIV, syphilis and hepatitis C prevention interventions in Regina, Saskatchewan \u2013 a protocol"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1331-1222","authenticated-orcid":false,"given":"Andrew D","family":"Eaton","sequence":"first","affiliation":[{"name":"Jane Addams College of Social Work, University of Illinois Chicago, Chicago, Illinois, USA"},{"name":"Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada"},{"name":"Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan W","family":"Rowe","sequence":"additional","affiliation":[{"name":"Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada"},{"name":"Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiny Mary","family":"Varghese","sequence":"additional","affiliation":[{"name":"AIDS Programs South Saskatchewan (APSS), Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"House","sequence":"additional","affiliation":[{"name":"Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Pang","sequence":"additional","affiliation":[{"name":"Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada"},{"name":"Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Kwan","sequence":"additional","affiliation":[{"name":"Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pam","family":"Ford","sequence":"additional","affiliation":[{"name":"Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada"},{"name":"SrX Health and Omega Nurses, Regina, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidya Dhar","family":"Reddy","sequence":"additional","affiliation":[{"name":"AIDS Programs South Saskatchewan (APSS), Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tashia","family":"Acoose","sequence":"additional","affiliation":[{"name":"AIDS Programs South Saskatchewan (APSS), Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Littleford","sequence":"additional","affiliation":[{"name":"AIDS Programs South Saskatchewan (APSS), Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Lang","sequence":"additional","affiliation":[{"name":"Saskatchewan Health Authority, Regina, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin S","family":"Foreman","sequence":"additional","affiliation":[{"name":"Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolee","family":"Sasakamoose","sequence":"additional","affiliation":[{"name":"Faculty of Education, University of Regina, Regina, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8801-1999","authenticated-orcid":false,"given":"Mamata","family":"Pandey","sequence":"additional","affiliation":[{"name":"Saskatchewan Health Authority, Regina, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1050-6067","authenticated-orcid":false,"given":"Priscilla","family":"Medeiros","sequence":"additional","affiliation":[{"name":"Edwin S.H. 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