Abstract
ProblemEarly detection of syphilis-infected people followed by effective treatment is essential for syphilis prevention and control.ApproachStarting in 2010 the local health authority in Yunnan province, China, developed a network of 670 service sites for syphilis testing, diagnosis and treatment or for testing-only with referral for further diagnosis and treatment. Point-of-care tests for syphilis and syphilis interventions were integrated into the existing human immunodeficiency virus (HIV) prevention and control programme. To improve the syphilis services, a pay-for-performance scheme was introduced in which providers were paid for testing and treating patients.Local settingYunnan province is the region hardest hit by HIV infection and disproportionately burdened with syphilis cases in China.Relevant changesThe proportion of attendees at voluntary counselling and testing clinics who were tested for syphilis increased from 46.2% (32 877/71 162) in 2010 to 98.2% (68 012/69 259) in 2015. Syphilis-infected cases treated with the recommended therapy increased from 26.6% (264/993) in 2010 to 82.5% (453/549) in 2015 at designated testing, diagnosis and treatment sites.Lessons learntThe strategy greatly increased the uptake of syphilis testing and treatment among people at risk. Introduction of point-of-care tests for syphilis increased coverage of the testing services. Introduction of a pay-for-performance scheme seemed to motivate health-care providers to undertake syphilis intervention services.
Highlights
Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum subspecies pallidum
The three settings are: (i) sexually transmitted disease clinics; (ii) human immunodeficiency virus (HIV) testing clinics; and (iii) out-of-clinic settings where outreach services are delivered to sex workers and men who have sex with men
Screening started in antenatal clinics after 2011 when syphilis was integrated into a separate programme for prevention of mother-to-child transmission of HIV and hepatitis B virus.[8]
Summary
Wanyue Zhang,a Hongbin Luo,a Yanling Ma,a Yan Guo,a Qingyan Fang,a Zhifang Yang,a Xiujie Zhang,a Xiaobin Zhang,a Manhong Jiaa & Xiang-Sheng Chenb. Approach Starting in 2010 the local health authority in Yunnan province, China, developed a network of 670 service sites for syphilis testing, diagnosis and treatment or for testing-only with referral for further diagnosis and treatment. To improve the syphilis services, a pay-for-performance scheme was introduced in which providers were paid for testing and treating patients. Local setting Yunnan province is the region hardest hit by HIV infection and disproportionately burdened with syphilis cases in China. Syphilis-infected cases treated with the recommended therapy increased from 26.6% (264/993) in 2010 to 82.5% (453/549) in 2015 at designated testing, diagnosis and treatment sites. Introduction of pointof-care tests for syphilis increased coverage of the testing services. Introduction of a pay-for-performance scheme seemed to motivate health-care providers to undertake syphilis intervention services
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