Syphilis/HIV Early Rapid Response (SHIVER): Community-Driven Point-of-Care Testing (POCT) Across Diverse Sites in Saskatchewan, Canada

Background: Saskatchewan faces a growing public health challenge, with outbreaks of infectious syphilis and a continued increase in new HIV diagnoses. Rural, remote, and underserved populations experience disproportionate burdens due to barriers to timely testing, diagnosis, treatment, and linkage to care. The Syphilis/HIV Early Rapid Response (SHIVER) project implemented an innovative point-of-care testing (POCT) and treatment model to improve access to rapid diagnosis, immediate treatment, and care for individuals in inner-city, rural, remote, and underserved communities across Saskatchewan, Canada. Methods: Individuals aged ≥16 years were offered POCT for syphilis and/or HIV based on non-random criteria. Standard serology was collected according to provincial guidelines. Participants with a positive syphilis POCT result were offered immediate treatment, when appropriate, and follow-up testing. Those with a positive HIV POCT received counselling, confirmatory testing, and expedited linkage to care. Results: Between February 2023 and November 2024, 1797 participants were enrolled. Syphilis POCT was completed by 1781 participants, including 319 (17.9%) first-time testers. HIV POCT was completed by 1387 participants, including 141 (10.2%) first-time testers. The program achieved a diagnostic yield of 16.45% for syphilis and 3.39% for HIV. Integrating dual POCT in a single encounter increased testing opportunity, improved case detection, and minimized procedural burden for participants. Conclusions: This flexible POCT model successfully expanded access to testing, immediate treatment, and timely linkage to care for populations at the highest risk of syphilis and HIV. Its emphasis on community partnerships and culturally safe service delivery supports a scalable model that can improve access to infectious disease care in underserved communities. Trial Registration: ClinicalTrials.gov (NCT05863117) Date of Registration: 19 April 2023.