The Impact of Integration of Rapid Syphilis Testing during Routine Antenatal Services in Rural Kenya

Abstract

We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into routine antenatal clinic (ANC) services in two rural districts in Nyanza Province, Kenya. In February 2011, nurses from 25 clinics were trained in using RSTs and documenting test results and treatment. During March 2011–February 2012, free RSTs and treatment kits were provided to clinics for use during ANC visits. We analyzed ANC registry data from eight clinics during the 12-month periods before and during RST program implementation and compared syphilis testing, diagnosis, and treatment during the two periods. Syphilis testing at first ANC visit increased from 18% (279 of 1,586 attendees) before the intervention to 70% (1,123 of 1,614 attendees) during the intervention (P < 0.001); 35 women (3%) tested positive during the intervention period compared with 1 (<1%) before (P < 0.001). Syphilis treatment was not recorded according to training recommendations; seven clinics identified 28 RST-positive women and recorded 34 treatment kits as used. Individual-level data from three high-volume clinics supported that the intervention did not negatively affect HIV test uptake. Integrating RSTs into rural ANC services increased syphilis testing and detection. Record keeping on treatment of syphilis in RST-positive women remains challenging.

Assessment of the impact of rapid syphilis tests on syphilis screening and treatment of pregnant women in Zambia

“…With the scale-up of RST implementation in Zambia and elsewhere, a focus on the treatment of seroreactive women is essential to ensure the intended impact of this investment. A recent article described similar results in Kenya, where no treatment data were recorded for any woman tested following the introduction of RSTs [15].…”

“…However, there was no evaluation up to 12 months or assessment of potential drop-off after initial staff training. Recently, a Kenyan evaluation demonstrated increased testing uptake at 12 months following initial RST training, but did not provide data regarding initial use of RST immediately after training [15].…”

Can incentives reduce the barriers to use of antenatal care and delivery services in Kenya?: Results of a qualitative inquiry

“…3 To increase care-seeking, pregnant women in the program received three incentives: a hygiene kit (Waterguard water treatment solution and soap) at the first and third ANC visits; protein-fortified flour ( unga ) at the second and fourth ANC visits; and a delivery kit (surgical gloves, a sterile razor blade, swaddling cloth, and water storage container with a tap) at delivery in health facilities. At the first ANC visit all women were offered free screening with a rapid syphilis test kit and free treatment for women testing positive 4 (rapid HIV tests were already standard practice of ANC care). An evaluation of this program, which included baseline and follow-up surveys of a population of 201 pregnant women, showed statistically significant increases from pre-intervention pregnancies to post-intervention pregnancies in the percentage of women with four or more ANC visits (55% vs. 76%, p<.01), health facility deliveries (41% vs. 68%, p<.01), and post-natal checks (38% vs. 62%, p<.01).…”

“…An evaluation of this program, which included baseline and follow-up surveys of a population of 201 pregnant women, showed statistically significant increases from pre-intervention pregnancies to post-intervention pregnancies in the percentage of women with four or more ANC visits (55% vs. 76%, p<.01), health facility deliveries (41% vs. 68%, p<.01), and post-natal checks (38% vs. 62%, p<.01). 4 We performed a qualitative inquiry to understand pregnant women and nurses’ perceptions of incentives employed to reduce barriers to use of ANC and delivery services.…”

The role of Point-of-Care testing in the diagnosis of syphilis

“…POCT is generally well accepted by clients and health professionals to diagnose either HIV or syphilis, as demonstrated in Lima, Peru [57]; Manaus, Brazil [56]; India [40]; Kenya [58]; Tanzania [49,59]; China; Uganda; Zambia [49]; Canada [27]; and England [54]. Clients were satisfied in receiving the test results rapidly in the first visit [24,49], with no need to come back for results.…”