Three infections, one fight: Protocol for an implementation study to map needle prevalence and implement HIV, syphilis, and hepatitis C prevention interventions in Regina, Saskatchewan

Introduction: Saskatchewan is facing a public health crisis driven by high rates of HIV, syphilis, and hepatitis C (HCV) infections, particularly among people who use drugs (PWUD). Injection drug use is a major contributor to these syndemic infections, exacerbated by structural barriers such as stigma, poverty, and limited culturally safe healthcare. Innovative, community-informed approaches are urgently needed to improve prevention, testing, and linkage to care.Methods and analysis: This study will implement a rapid assessment and response system in Regina, Saskatchewan, Canada integrating geospatial mapping of community needle prevalence with pop-up interventions. Needle hotspot maps will be used to guide the deployment of community-based pop-up events offering point-of-care testing for HIV, syphilis, and HCV, alongside education on pre- and post-exposure prophylaxis (PrEP and PEP). A convergent participatory mixed-methods design will be used to evaluate feasibility, acceptability, and effectiveness, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintainence (RE-AIM) framework. Quantitative data will assess changes in knowledge of PrEP and PEP, satisfaction with the intervention, and report new diagnoses and participant demographics descriptively. A qualitative sub-study will include 30 participants and will explore experiences with the intervention, barriers to care, and perceptions of service delivery.Ethics and dissemination: Ethical approval has been obtained from the Research Ethics Board of the Saskatchewan Health Authority (#24-91). Findings will be disseminated through peer-reviewed publications, conference presentations, and community reporting. This study may provide a model of community-based, geospatial testing and education that could be upscaled and adapted elsewhere.Registration: Open Science Framework https://doi.org/10.17605/OSF.IO/HVK3B