Spotlight on the STBBI Field Surveillance Program

An applied federal epidemiology program that builds partnerships to strengthen surveillance capacity for STBBIs

STBBI Field Surveillance Program

Mission

The Field Surveillance Officers (FSO) from the STBBI Field Surveillance Program (FSO Program) provide daily, on-site, epidemiological support to provinces on joint federal and provincial (FP) sexually transmitted and blood-borne infection (STBBI) surveillance and epidemiology initiatives.

A unique field service program with six permanent federal employees placed in provincial public health authorities including laboratories.

Strategic alignment

• Logically located in the STBBI Surveillance Division, Centre for Communicable Diseases and Infection Control (CCDIC)
• Synergistically aligned with Agency STBBI subject matter experts

Trust

• Built trusting relationships that strengthen FP relations through a stable staff and program placement within the Agency

Specialized expertise

• Specialized team with a deep expertise in STBBI and the ability to work across disciplines, sectors and communities
• Demonstrated excellence in the public health workforce^{Footnote 1}

Trail blazer

• Was the first agency field surveillance program to permanently place federal staff in provincial public health authorities

Reciprocity

• Long-standing mutually beneficial arrangement between the agency (epidemiological expertise) and the province (STBBI data sharing), improving our ability to meet agency priorities such as progress towards global elimination targets and national surveillance

Linkage

• Established liaison role between the Agency and provincial public health authorities
• Described by partners as the glue that links different levels of the public health system together^{Footnote 2}

Coverage across the country

Figure 1 - Text description

Field surveillance officers are located in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Nova Scotia.

Collaboration between provincial and federal teams

• At the operational level, each FSO works directly with provincial teams.
• Each year, the FSO and their provincial and federal supervisors work together to develop a work plan.
• Every five years, the Memorandum of Agreement between the Agency and each province is renewed.

The Program supports the Agency and CCDIC mandates through:

• Providing annual provincial STBBI surveillance data
• Supplying provincial estimates for assessing Canada's progress towards STBBI elimination targets
• Providing a liaison function for the Agency through established long-standing relationships with provincial counterparts
• Leading or taking part in provincial STBBI surveillance activities that monitor at-risk and key populations and barriers to service access

Many successes and contributions in the past 22 years

• Supporting work to establish HIV elimination targets
• Improving timely access to quality data
• Contributing to providing data for action on key populations for STBBI prevention and control
• Representing the Agency at various national and international tables
• Conducting applied research and knowledge translation
• Responding to syphilis outbreaks
• Contributing to the development of STBBI case definitions
• Providing long-term epidemiological support to provincial COVID-19 response

A history of service and STBBI expertise

• 2000: The FSO Program is established to enhance and integrate the national STBBI (and emerging retroviruses) surveillance.
• 2001: FSOs start to provide data, analysis, and liaison with provincial partners for national HIV surveillance.
• 2002: FSOs provide data and analysis for the first Canadian report on HIV strain and drug resistance surveillance.
• 2004: The Agency was established as a response to the SARS outbreak (2003).
• 2008: Report of the Auditor General demonstrates that surveillance results contributed to policy decisions.
• 2009: The ON FSO provides leadership for the establishment of the Laboratory Enhancement Program in Ontario, for the provision of risk factor data for national HIV surveillance.
• 2013: The MB FSO provides leadership for the establishment of the provincial site for new Enhanced Surveillance of Antimicrobial Resistant Gonorrhea system.
• 2014: The ON FSO is instrumental in the development of an HIV DataMart using PHOL laboratory information systems for ON, which is critical in supporting HIV cascade measures
• 2016: Canada announces support to Global Health Sector Strategy for HIV/ AIDS including 90-90-90 targets. FSOs provide ongoing support for the completion of provincial estimates used in reporting on Canada's progress towards global elimination targets.
• 2019: FSOs provide input on indicators and targets work for the Pan-Canadian STBBI Framework for Action
• 2019: The NS, MB and BC FSOs start providing or contributing to outbreak investigation data for the new Syphilis Outbreak Investigation Coordination Committee established in response to syphilis outbreaks across the country
• 2020: FSOs are reassigned within 24 hours to support provincial and federal response to the COVID-19 pandemic.
• 2021: FSOs continue supporting COVID-19 response and advancing national STBBI priorities
• 2022: The ON FSO takes on writing of the national HIV surveillance report in a resource-limited context.

Federal deliverables

• Validation and submission of provincial STBBI data for national surveillance
• Liaison with local, provincial and federal partners on STBBI and other notifiable disease surveillance issues
• Coordination of the provincial input to national estimates of progress towards global HIV elimination targets
• Co-authorship of scientific publications with the provinces

Provincial surveillance deliverables

• Analysis of surveillance data to inform program and policy development
• Preparation of provincial surveillance products (e.g., reports, infographics, manuscripts, briefing notes)
• Participation in STBBI enhanced surveillance initiatives and outbreak investigations (e.g., for syphilis outbreaks)
• Agency representation at provincial working groups

Appendix: Our publications

Charlton, C. L., Nguyen, L. T., Bailey, A., Fenton, J., Plitt, S. S., Marohn, C., Lau, C., Hinshaw, D., Lutsiak, C., Simmonds, K., Kanji, J. N., Zelyas, N., Lee, N., Mengel, M., & Tipples, G. (2021). Pre-Vaccine Positivity of SARS-CoV-2 Antibodies in Alberta, Canada during the First Two Waves of the COVID-19 Pandemic. Microbiology spectrum, 9(1), e0029121. https://doi.org/10.1128/Spectrum.00291-21

PHAC (2020). Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90.html

Round, J. M., Savaryn, B., Plitt, S. S., Shafran, S. D., & Charlton, C. L. (2021). Identifying gaps in the treatment of hepatitis C in patients co-infected with HIV in Edmonton, Alberta. Annals of hepatology, 23, 100283. https://doi.org/10.1016/j.aohep.2020.10.011

Popovic, N., Yang, Q., Haddad, N., Weeks, A., & Archibald, C. (2019). Improving national surveillance of new HIV diagnoses. Canada communicable disease report = Releve des maladies transmissibles au Canada, 45(12), 313–316. https://doi.org/10.14745/ccdr.v45i12a02

Liu, J., Wilton, J., Sullivan, A., Marchand-Austin, A., Rachlis, B., Giles, M., Light, L., Sider, D., Kroch, A. E., Gilbert, M., & Ontario HIV Epidemiology and Surveillance Initiative (2019). Cohort profile: Development and profile of a population-based, retrospective cohort of diagnosed people living with HIV in Ontario, Canada (Ontario HIV Laboratory Cohort). BMJ open, 9(5), e027325. https://doi.org/10.1136/bmjopen-2018-027325

Wilton, J., Liu, J., Sullivan, A., Rachlis, B., Marchand-Austin, A., Giles, M., Light, L., Rank, C., Burchell, A. N., Gardner, S., Sider, D., Gilbert, M., Kroch, A. E., & Ontario HIV Epidemiology and Surveillance Initiative (2019). Trends in HIV care cascade engagement among diagnosed people living with HIV in Ontario, Canada: A retrospective, population-based cohort study. PloS one, 14(1), e0210096. https://doi.org/10.1371/journal.pone.0210096

Haddad, N., Robert, A., Weeks, A., Popovic, N., Siu, W., & Archibald, C. (2019). HIV in Canada-Surveillance Report, 2018. Canada communicable disease report = Releve des maladies transmissibles au Canada, 45(12), 304–312. https://doi.org/10.14745/ccdr.v45i12a01

Plitt, S. S., Osman, M., Sahni, V., Lee, B. E., Charlton, C., & Simmonds, K. (2016). Examination of a prenatal syphilis screening program, Alberta, Canada: 2010-2011. Canadian journal of public health = Revue canadienne de sante publique, 107(3), e285–e290. https://doi.org/10.17269/cjph.107.5320

Steinberg, M., Cook, D. A., Gilbert, M., Krajden, M., Haag, D., Tsang, P., Wong, E., Brooks, J. I., Merks, H., & Rekart, M. L. (2011). Towards targeted screening for acute HIV infections in British Columbia. Journal of the International AIDS Society, 14, 39. https://doi.org/10.1186/1758-2652-14-39