RESUMEN
Background: Canadian Arctic communities have experienced sustained syphilis transmission, with diagnoses rates 18-times higher than the national average. Remoteness from laboratory facilities leads to delays between syphilis screening and treatment, contributing to onward transmission. Rapid diagnostic tests can eliminate treatment delays via testing at the point-of-care. This study aims to describe syphilis diagnostic gaps and to estimate the impact of introducing rapid diagnostic tests at the point-of-care on syphilis transmission. Methods: To assess the population-level impact of deploying rapid diagnostic tests, an individual-based model was developed using detailed surveillance data, population surveys, and a prospective diagnostic accuracy field study. The model was calibrated to syphilis diagnoses (2017-2022) from a community of approximately 1,050 sexually active individuals. The impacts of implementing rapid diagnostic tests using whole blood (sensitivity: 92% for infectious and 81% for non-infectious syphilis; specificity: 99%) from 2023 onward was calculated using the annual median fraction of cumulative new syphilis infections averted over 2023-2032. Findings: The median modeled syphilis incidence among sexually active individuals was 44 per 1,000 in 2023. Males aged 16-30 years exhibited a 51% lower testing rate than that of their female counterparts. Maintaining all interventions constant at their 2022 levels, implementing rapid diagnostic tests could avert a cumulative 33% (90% credible intervals: 18-43%) and 37% (21-46%) of new syphilis infections over 5 and 10 years, respectively. Increasing testing rates and contact tracing may enhance the effect of rapid diagnostic tests. Interpretation: Implementing rapid diagnostic tests for syphilis in Arctic communities could reduce infections and enhance control of epidemics. Such effective diagnostic tools could enable rapid outbreak responses by providing same-day testing and treatment at the point-of-care. Funding: Canadian Institutes of Health Research.
RESUMEN
The authors' goal was to identify factors explaining intention to encourage a patient to follow complementary and alternative medicine (CAM) treatment among general practitioners (GPs), fourth-year medical students, and residents in family medicine. They surveyed 500 GPs and 904 medical students via a self-administered mailed questionnaire that they based on the Theory of Planned Behavior. Respondents expressed a neutral level of intention to encourage CAM approach. Variables explaining 75% of variance of intention of all participants were: moral norm, beta=0.34, p<.0001; perceived behavioral control, beta=0.29, p<.0001; attitude, beta=0.22, p<.0001; descriptive norm, beta=0.13, p<.0001; and professional status, (GPs, beta=-0.07, p<.0001; residents, beta=-0.07, p<.0001). Facilitating conditions and developing a better perception of control over perceived obstacles could help enhance health-care practitioners' intentions to use CAM. Also, a clear position on the part of the medical community would help to define a professional norm in line with the moral norm.