Coverage Of Syphilis Screening Research Articles

Towards the elimination of mother to child transmission of syphilis 2015–2020: practice and progress in Zhejiang province, eastern China

ObjectivesTo estimate the progress towards elimination of mother-to-child transmission (EMTCT) of syphilis in Zhejiang province.MethodsData were obtained from Zhejiang provincial EMTCT network. Childbearing women infected with syphilis during 2015–2020 were recruited. Joinpoint mode was used to analyze changing trends in syphilis screening, treatment and adverse pregnancy outcomes (APOs). Changing trends were presented as the annual percentage of change (APC). Multivariate logistic regression mode was used to analyzerisk factors of APOs.ResultsOf 3,658,266 participants, an average maternal syphilis incidence was 0.38%. From 2015 to 2020, the coverage of syphilis screening in pregnancy (96.31% to 99.24%; P < 0.001) and coverage of antenatal health care (ANC) within 13 gestational weeks (55.27% to 77.82%; P = 0.002) were increased.The coverage of maternal syphilis treatment(88.30% to 98.25%; P = 0.001) and adequate treatment (66.92% to 83.37%; P = 0.001) were also increased. Over the years, the APC was -19.30% (95%CI:-24.33 ~ -13.92, P = 0.001) in perinatal death,-26.55% in congenital syphilis(95%CI:-38.75 ~ -11.92, P = 0.009), and -14.67% in other neonatal complications (95%CI:-23.96 ~ -4.24, P = 0.019).In 2020, 11.58% of women had APOs. The rate of syphilis infection during pregnancy increased among women aged (< 20 years) or (≥ 35 years), multiparous, and with pregnancy complications (all P < 0.05).APOs risk increased in women with higher maternal RPR/TRUST titers while it decreased in women who had (adequate) therapy, early ANC, and aged in 21–34 years (all P < 0.001).ConclusionsDespite steady progress towards the goal of EMTCT in implementing universal screening and treatment, syphilis continuously affects a large number of pregnant women. Increasing vulnerable women, small proportions of inadequately treated and delay in early ANC should be noticed.

Estimating Benzathine Penicillin Need for the Treatment of Pregnant Women Diagnosed with Syphilis during Antenatal Care in High-Morbidity Countries.

BackgroundCongenital syphilis continues to be a preventable cause of global stillbirth and neonatal morbidity and mortality. Shortages of injectable penicillin, the only recommended treatment for pregnant women and infants with syphilis, have been reported by high-morbidity countries. We sought to estimate current and projected annual needs for benzathine penicillin in antenatal care settings for 30 high morbidity countries that account for approximately 33% of the global burden of congenital syphilis.MethodsProportions of antenatal care attendance, syphilis screening coverage in pregnancy, syphilis prevalence among pregnant women, and adverse pregnancy outcomes due to untreated maternal syphilis reported to WHO were applied to 2012 birth estimates for 30 high syphilis burden countries to estimate current and projected benzathine penicillin need for prevention of congenital syphilis.ResultsUsing current antenatal care syphilis screening coverage and seroprevalence, we estimated the total number of women requiring treatment with at least one injection of 2.4 MU of benzathine penicillin in these 30 countries to be 351,016. Syphilis screening coverage at or above 95% for all 30 countries would increase the number of women requiring treatment with benzathine penicillin to 712,030. Based on WHO management guidelines, 351,016 doses of weight-based benzathine penicillin would also be needed for the live-born infants of mothers who test positive and are treated for syphilis in pregnancy. Assuming availability of penicillin and provision of treatment for all mothers diagnosed with syphilis, an estimated 95,938 adverse birth outcomes overall would be prevented including 37,822 stillbirths, 15,814 neonatal deaths, and 34,088 other congenital syphilis cases.ConclusionPenicillin need for maternal and infant syphilis treatment is high among this group of syphilis burdened countries. Initiatives to ensure a stable and adequate supply of benzathine penicillin for treatment of maternal syphilis are important for congenital syphilis prevention, and will be increasingly critical in the future as more countries move toward elimination targets.

Multisite Laboratory Evaluation of a Dual Human Immunodeficiency Virus (HIV)/Syphilis Point-of-Care Rapid Test for Simultaneous Detection of HIV and Syphilis Infection.

Background. Recently, test developers have created rapid point-of-care tests that can simultaneously detect multiple infections within the same specimen using a single device. The SD BIOLINE Duo HIV/Syphilis rapid point-of-care test uses a solid-phase immunochromatographic assay to detect immunoglobulin (Ig)G, IgM, and IgA antibodies to human immunodeficiency virus (HIV)-specific antigens (HIV-1 gp41, sub O, HIV-2 gp36) and recombinant Treponema pallidum antigen (17 kDa) in human serum. This study was a multisite laboratory-based evaluation of the performance of SD BIOLINE HIV/Syphilis Duo test using previously characterized sera in 6 countries.Methods. Laboratories in Ghana, Mexico, Laos, Togo, Kenya, and Myanmar participated in the evaluation during 2012–2013. Each site characterized sera using T pallidum particle agglutination assay or T pallidum hemagglutination assay and HIV enzyme immunoassay, Western blot, and/or HIV antibody rapid tests. Those gold standard test results were compared with SD BIOLINE Duo test results. We calculated the sensitivity and specificity of test performance and used the exact binomial method to calculate 95% confidence intervals (CIs).Results. The sensitivity and specificity for the HIV antibody test component (n = 2336) were estimated at 99.91% (95% CI, 99.51% and 100%) and 99.67% (95% CI, 99.16% and 99.91%), respectively. For the T pallidum test component (n = 2059), the sensitivity and specificity were estimated at 99.67% (95% CI, 98.82% and 99.96%) and 99.72% (95% CI, 99.29% and 99.92%), respectively.Conclusions. The sensitivity and specificity of the SD BIOLINE HIV/Syphilis Duo test were consistently high across sera specimens from 6 countries around the world. Dual rapid tests should be considered for improved HIV and syphilis screening coverage.

Integrating syphilis screening in a large-scale HIV prevention program for key populations: the Avahan experience from India

Documented experiences from India on the implementation of syphilis screening in large-scale HIV prevention programs for "key populations at higher risk" (KPs) are limited. Avahan is a large-scale HIV prevention program providing services to more than 300,000 KPs in six high HIV prevalence states of India since 2004. Avahan clinics provide a sexually transmitted infection service package which includes bi-annual syphilis screening. The trends in the coverage of syphilis screening among Avahan clinic attendees were studied retrospectively. Screening was performed using either the Rapid Plasma Reagin (RPR) test or point-of-care immunochromatographic strip test (ICST). Clinic records from 2005 to 2009 were collated in an individual tracking database and analyzed with STATA-10. Initially the coverage of syphilis screening (2.6% in 2005) was constrained by the availability and operational complexity of the RPR test. After its introduction in 2007, the use of ICST for screening increased from 7.4% to 77.0% and the proportion of clinic attendees screened increased from 9.0% to 21.6% during 2007-2009. The RPR reactivity rates declined from 6.6% (2006) to 4.4% (2009). The data showed improved rates of screening of clinic attendees and declining trends in sero-reactivity over time. The introduction of point-of-care syphilis tests may have contributed to the improved coverage of syphilis screening. The ICST may be considered for initial syphilis screening at other resource-constrained primary care sites in India such as ante-natal clinics and other KP interventions.

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

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.

Coverage of Antenatal Syphilis Screening and Predictors for Not Being Screened in Ulaanbaatar, Mongolia

To measure the coverage of antenatal syphilis screening and identify factors related to women not being screened. To assess the syphilis control program in Mongolia. Antenatal care records of women in 16 antenatal care clinics of 6 districts were reviewed. Additionally, postpartum women were interviewed to identify potential factors for not being screened. Among 3,519 antenatal records, the coverage of syphilis screening was 77.7%. Of 2,735 screened women, 54 (2.0%) had reactive serological results and subsequently received treatment. Four late antenatal care comers delivered infants with congenital syphilis. Being unscreened was significantly associated with late antenatal care (odds ratio OR=2.6), lack of knowledge (OR=5.5), history of previous sexually transmitted infection (OR=3.7), and living far from screening services (OR=4.9). The coverage of antenatal syphilis screening is still low, with poor contact tracing. More efforts are needed to promote early antenatal care visit and improve syphilis screening systems.