Stopping syphilis on the streets: embedding point of care testing within a street outreach nursing service

Background Nationally, the increase in syphilis notifications over recent years has demonstrated persistent bridging across to wider populations, particularly women of reproductive age. Populations experiencing adverse social determinants, caught in a cycle of marginalisation and social exclusion through mental ill-health, alcohol and drug misuse, and economic and housing stress, have increasingly become susceptible. Methods The aim of this pilot was to develop and implement a protocol for delivering syphilis point of care testing (POCT) through a street-based nursing outreach program, specifically to the homeless, with a focus on women. The evaluation utilised a multi-methods approach to assess the feasibility and acceptability of the service, i.e. qualitative through discussions with nursing staff and clients; and quantitative through the collection and analysis of simple demographic (gender, Indigenous status, housing, age status) and test data. Results The 6-month pilot demonstrated the potential utility of opportunistic syphilis testing and the ease with which the POCT could be incorporated within existing service delivery by outreach nursing teams. Nurses reported the test as easy to apply. The pilot was received well by nurses who gained confidence in the delivery of sexual health education and testing. Nonetheless, despite the establishment of testing, management, and referral protocols, as well as thorough training and preparation, a number of important challenges became apparent through the course of the pilot, particularly with respect to recruitment and follow-up of test results. Conclusions This project effectively embedded a rapid diagnostic assay (Syphilis POCT) within a well-established, outreach health service working within the most marginalised inner-city communities. Nonetheless the challenge with referring syphilis reactive clients for follow-up has necessitated a review of referral protocols and what additional services, including treatment, can be delivered by nurses at the point of first engagement. The need for linking outreach teams with a broad range of other accessible primary health services is considered a priority to ensure efficient referral of homeless persons and minimise loss to follow-up.