P1-S6.35 One finger stick, two tests: integrating syphilis and HIV Rapid tests for antenatal care and reproductive health services

Abstract

Background Mother-to-Child Transmission of HIV and Congenital Syphilis are two important public health problems in many developing countries. In Peru, coverage of syphilis screening is suboptimal, test results can take weeks and a high proportion of women screened are not treated, much less their sex partners. The objective of this study was to demonstrate the feasibility of implementing syphilis and HIV rapid tests at antenatal care and reproductive health services and to measure its effect on coverage of maternal syphilis screening and treatment coverage. Methods We trained midwives from 16 health centers, to offer syphilis rapid tests (Syphilis 3.0 BioLine) to women 16 to 55 years old receiving antenatal care (ANC) and seen at the delivery or miscarriage services, and to integrate it with HIV rapid tests already in place at the health network, but which were until then done from venous blood by laboratory technicians and with results given in 15 to 30 days. Results 4497 women were screened, from January to November 2010. Prevalence of syphilis (RPR reactive, TPPA(+)) was 0.9% in ANC, 0.7% in delivery services and 1.9% at the miscarriage services. The prevalence of HIV by rapid test was 0.3%. The overall coverage for syphilis and HIV rapid tests was 93% during the study, compared to the 35% coverage of RPR testing reported for 2009 (Abstract P1-S6.35 figure 1). Previous coverage of HIV testing was not documented. Test results were given to 100% of women within 20 min of finger stick blood collection during the first contact with health providers, compared to a 27 days delay found in 2009. Treatment rates for syphilis also improved from 51% in 2009 to 93% in 2010. Whereas previously there was no system in place for registering partner treatment, our data shows that 59% of partners of positive women received treatment for syphilis during the study period. Key factors in the success of implementation in Callao-Peru; were ongoing training, monitoring, and supervision of health providers who performed the rapid tests. Conclusions Implementation of syphilis rapid test proved feasible, acceptable and effective in improving screening and treatment coverage and can serve as a powerful catalyst for improvements in quality of care.