Rapid Syphilis Tests as Catalysts for Health Systems Strengthening: A Case Study from Peru

Abstract

ObjectivesUntreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT) offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening.MethodsThe study was implemented from September 2009–November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability.ResultsBefore the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the “two for one strategy”, offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%.ConclusionsImplementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1) engaging the authorities; (2) dissipating tensions between providers and identifying champions; (3) training according to the needs; (4) providing monitoring, supervision, support and recognition; (5) sharing results and discussing actions together; (6) consulting and obtaining feedback from users; and (7) integrating with other services such as with rapid HIV testing.

Laboratory Evaluation of a Dual-Path Platform Assay for Rapid Point-of-Care HIV and Syphilis Testing

“…For Treponema pallidum antibody detection, the electronic reader with the default cutoff value of 10 had the best sensitivity and specificity. Our results are comparable to those of laboratory evaluations that were conducted previously with different point-of-care tests for HIV and treponemal antibody detection in sera and whole blood, which also yielded high performance values for sensitivity and specificity (1,(5)(6)(7)(11)(12)(13). In our evaluation, the sensitivity of the Chembio DPP HIV-syphilis rapid test to detect HIV antibodies was somewhat greater than its sensitivity to detect syphilis antibodies, in concurrence with several other studies (5,6,11,12,14).…”

“…apid multiplex point-of-care tests are increasingly available means to screen for syphilis and HIV infections (1)(2)(3)(4). Dual screening tests for antibodies to HIV and Treponema pallidum have been evaluated in serum and venipuncture whole-blood samples, showing excellent sensitivity and specificity (5)(6)(7).…”

Syphilis testing in antenatal care: Policies and practices among laboratories in the Americas

“…Furthermore, syphilis screening and treatment is recognized as one of the most highly cost-effective public health interventions [4], recommended as part of essential antenatal care (ANC) globally [5]. Despite this, preventable congenital syphilis infections continue to occur because pregnant women-especially those who are poor or living in rural settings-are often not screened according to national guidelines [6][7][8]. The most commonly used serologic screening tests for syphilis require specialized reagents and equipment and trained technicians-a laboratory capacity typically unavailable outside larger hospital or reference laboratories in most low-and middle-income countries [9].…”

“…The most commonly used serologic screening tests for syphilis require specialized reagents and equipment and trained technicians-a laboratory capacity typically unavailable outside larger hospital or reference laboratories in most low-and middle-income countries [9]. However, globally, many pregnant women receive ANC at lower-level facilities without such laboratory capacity [6][7][8]. To date, little has been reported in the Americas region regarding the current state of laboratory-based syphilis testing, including the types of tests available, algorithms used, or testing quality.…”

“…Nonetheless, several countries have continued to lag on coverage of syphilis screening during pregnancy [14], indicating that reaching the ANC testing coverage targets continues to be difficult for many countries. New diagnostics, such as point-of-care (treponemal) rapid syphilis tests (RSTs), may be more practical and effective than traditional diagnostics in ANC settings where rapid treatment is critical [6,15].…”