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.
Highlights
Mother-to-child transmission of syphilis continues to be a problem, with more than 2 million pregnancies each year in women with syphilis [1]
Most countries have existing policies for universal syphilis screening during pregnancy, but implementation of such policies is weak, especially in developing countries, where congenital syphilis remains a major public health problem [5]
This paper presents the experience of the introduction of point-of–care tests (POCT) for syphilis in Peru to illustrate this technology as catalyst for improving health delivery and health systems
Summary
Mother-to-child transmission of syphilis continues to be a problem, with more than 2 million pregnancies each year in women with syphilis [1]. In at least 69% of them, adverse pregnancy outcomes are estimated to happen, including congenital syphilis, miscarriage, stillbirth, low birth-weight, and preterm labor. Most countries have existing policies for universal syphilis screening during pregnancy, but implementation of such policies is weak, especially in developing countries, where congenital syphilis remains a major public health problem [5]. In six low-middle income countries, including Peru, introduction of POCT into health services to improve syphilis screening proved feasible, and resulted in increased proportions of pregnant women being screened and treated [7]. As any array of initiatives and strategies leading to improvements in access, coverage, quality or efficiency [8], has been identified as one of the critical steps towards the global elimination of congenital syphilis [5;9]
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