Evaluation of the Enhanced Syphilis Surveillance System - British Columbia, Canada, 2018

  • Public health surveillance
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Background:
From 2010 to 2015, the incidence of infectious syphilis increased nearly 5-fold in British Columbia (BC), Canada. In response, syphilis surveillance was enhanced in 2016 to improve collection of data on cases (i.e. geography, HIV co-infection, ocular syphilis) and partners. Using the enhanced data, Quarterly reports were developed for public health regional health authorities (RHAs) stakeholders. In 2018, an evaluation was initiated to determine whether the enhanced surveillance supported syphilis reduction efforts.

Methods:
Using The CDC Guidelines for Evaluating Public Health Surveillance System, three attributes were evaluated: data quality, sensitivity, and usefulness. Data quality was measured as the change in completeness of key variables before versus after enhanced surveillance was implemented (2010-2015 vs. 2016-2017, respectively). Significance was assessed using interrupted time series regression analysis. Sensitivity of ocular syphilis was determined by comparing enhanced surveillance data versus a chart review. Usefulness of enhanced reports was assessed through an online stakeholder questionnaire.

Results:
Data quality improved for postal code (38% vs. 13% missing, p<0.0001), but not other variables, such as sexual orientation or HIV co-infection. Enhanced surveillance did capture whether HIV was diagnosed at or around the time of syphilis diagnosis and viral load, which were not previously collected. Sensitivity to detect ocular syphilis was 97%. Stakeholders (n=9) rated the enhanced indicators as “useful/very useful” (89%). Reports were considered “very/extremely important” for monitoring regional trends (89%) and for supporting testing/clinical strategies (e.g. HIV pre-exposure prophylaxis). Stakeholders reported wanting data at lower geographic regions (78%), and in interactive dashboards (67%).

Conclusion:
Enhanced surveillance provided additional data to more thoroughly describe the epidemiology of syphilis in BC. It provided information needed by stakeholders to more accurately describe syphilis spatial epidemiology, and better assess the potential for HIV transmission, which informed regional programs. Additionally, stakeholder feedback was used to identify improvements to knowledge translation.

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