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.

Highlights

  • The World Health Organization (WHO) estimated that globally in 2008 1.4 million women had syphilis in pregnancy, causing approximately 520,000 adverse pregnancy outcomes including 305,000 perinatal deaths [1]

  • Of 1614 antenatal clinic (ANC) attendees recorded in the ANC registries in the eight clinics during the one-year intervention period, 1123 (70%) were tested for syphilis compared with 279 (18%) of 1586 ANC attendees recorded in ANC registries during the prior year (P < 0.001) (Table 1)

  • HIV test kits were more consistently available at ANC facilities than syphilis tests during the 12 months prior to the intervention, stock-outs in HIV test kits occurred for short periods during the intervention

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Summary

Introduction

The World Health Organization (WHO) estimated that globally in 2008 1.4 million women had syphilis in pregnancy, causing approximately 520,000 adverse pregnancy outcomes including 305,000 perinatal deaths [1]. Untreated maternal syphilis currently equals or exceeds HIV, neonatal tetanus, or malaria as a cause of perinatal mortality [2]. Adverse pregnancy outcomes can occur in up to 80% of affected pregnancies [4], with the most severe outcomes occurring in women with early (i.e., primary, secondary, or early latent) infections [3]. A recent meta-analysis adjusting for other causes of mortality estimated that, among asymptomatic women, untreated maternal syphilis caused stillbirth in 21% and neonatal death in 9% of affected pregnancies and led to low birth weight in 6% and congenital infection in 15% of surviving infants [5].

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