Syphilis Point-of-Care Tests (POCTs): Implementation Considerations in Canada

Starting in the early 2000s, the rate of infectious syphilis in Canada began rising. Since the mid-2010s, the rate among females, particularly females in their reproductive years, has increased rapidly. Coincident with this shift, congenital syphilis has re-emerged in Canada in recent years. Infectious and congenital syphilis disproportionately impact communities affected by social and structural determinants of health, including homelessness and inadequate or inaccessible health care services. These realities underscore the importance of emerging strategies, including rapid diagnostic tests that can be deployed at the point of care, as tools to help reverse these trends. Increased access to testing is one of the pillars of the Pan-Canadian Framework for Action on Sexually Transmitted and Blood-Borne Infections (STBBI) and the Government of Canada's STBBI Action Plan 2024-2030. The National Microbiology Laboratory Branch of the Public Health Agency of Canada has worked towards introducing rapid diagnostic tests including point-of-care tests (POCTs) for STBBI testing. With Health Canada's first approval of a syphilis POCT (bioLytical's INSTI MULTIPLEX HIV-1/2 Syphilis Ab Test) in 2023, it is timely to reflect on important implementation considerations for this and other syphilis POCTs in Canada. In this article, we aim to review antibody-detecting syphilis POCTs that are commercially available, their performance in recent Canadian field studies, and key contextual considerations for Canada in implementing POCTs for syphilis.