The need for integrated public health surveillance to address sexually transmitted and blood-borne syndemics

Abstract

A national approach to addressing sexually transmitted and blood-borne infections (STBBIs) was recently articulated in the Public Health Agency of Canada’s new A Pan-Canadian Framework for Action: Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030 . This Framework promotes an integrated approach, with a focus on the key populations that are affected by overlapping epidemics (i.e., syndemics). We advance the idea that integrating surveillance would be helpful in characterizing and understanding the populations, locations, risk behaviours and other drivers that contribute to STBBI syndemics. The creation of matched or linked data systems that would allow routine reporting of integrated data is challenged by the technical barriers of integrating data silos as well as by the privacy and ethical considerations of merging sensitive individual-level data. Lessons can be learned from jurisdictions where an improved understanding of syndemics, through integrated STBBI surveillance, has led to more efficient and effective operational, program and policy decisions. Emerging enablers include the development of data standards and guidelines, investment in resources to overcome technical challenges and community engagement to support the ethical and non-stigmatizing use of integrated data. The Framework’s call to action offers an opportunity for national discussion on priorities and resources needed to advance STBBI syndemic surveillance for local, regional and national reporting in Canada.

Global research on syndemics: A meta-knowledge analysis (2001-2020)

“…Syndemics research highlights an intersection of academic contributions from multiple scholarly disciplines, including medical anthropology, social epidemiology, health policy, health promotion, clinical sciences, and social sciences [6,33,61,73]. The combined use of multiple quantitative and qualitative methods has complemented the investigations of complex syndemic problems in current literature, which couldn't have been understood using any singlebest method [6,9,17] Global research on syndemics informs the deteriorating effects of cooccurring health problems in populations living under chronic social stressors [8,10,34,60].…”

“…From a health promotion perspective, it is critical to engage communities who are vulnerable to syndemics to increase their awareness on social determinants of cooccurring diseases [73,74].…”

STI epidemic re-emergence, socio-epidemiological clusters characterisation and HIV coinfection in Catalonia, Spain, during 2017–2019: a retrospective population-based cohort study

“…STIs and HIV have been described as synergic infections and should be viewed as a syndemic. 25 The WHO and other public health agencies have emphasised the importance of integrating surveillance of STIs, HIV and even viral hepatitis, and strengthening understanding of determinants of these infections by linking biological and behavioural surveillance, to enhance the identification and characterisation of populations at increased risk of infection. 10 25 Sociodemographic and socioeconomic are increasingly being established as more important risk factors of STI acquisition than individual behaviours, particularly among women from disadvantaged groups.…”

The 9th Canadian Symposium on Hepatitis C Virus: Advances in HCV research and treatment towards elimination

“…The health services research section began with an update on the Blueprint delivered by the Chairman of the Blueprint writing committee, Dr Jordan J Feld (University of Toronto, Toronto, Ontario, Canada). As a policy tool, the Blueprint is intended to complement the PHAC framework for the elimination of sexually transmitted bloodborne infections (1,57). It provides guidance, but it more specifically is meant to sketch out measurable objectives and tangible goals for achieving WHO HCV elimination targets (3).…”