Rapid Syphilis Tests as Catalysts for Health Systems Strengthening: A Case Study from Peru

Objectives Untreated 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. Methods The 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. Results Before 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%. Conclusions Implementation 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.

[1]  K. Hill.  The World Health Report 2000: Health Systems: Improving Performance , 2001 .

[2]  R. Peeling,et al.  Field performance of a rapid point-of-care diagnostic test for antenatal syphilis screening in the Amazon region, Brazil , 2011, International journal of STD & AIDS.

[3]  Rosanna W. Peeling,et al.  Evaluation of rapid diagnostic tests: syphilis , 2006, Nature Reviews Microbiology.

[4]  U. Reinhardt,et al.  The world health report 2000 - Health systems: improving performance , 2000 .

[5]  R. Steketee,et al.  Syphilis-associated perinatal and infant mortality in rural Malawi. , 1993, Bulletin of the World Health Organization.

[6]  Rosanna W. Peeling,et al.  Point-of-Care Tests to Strengthen Health Systems and Save Newborn Lives: The Case of Syphilis , 2012, PLoS medicine.

[7]  D. Watson-Jones,et al.  Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes. , 2002, The Journal of infectious diseases.

[8]  D. Grossman,et al.  Demonstrating Public Health at Work: A Demonstration Project of Congenital Syphilis Prevention Efforts in Bolivia , 2007, Sexually transmitted diseases.

[9]  N. Low,et al.  Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. , 2011, The Lancet. Infectious diseases.

[10]  G. Schmid,et al.  Onsite Rapid Antenatal Syphilis Screening With an Immunochromatographic Strip Improves Case Detection and Treatment in Rural South African Clinics , 2007, Sexually transmitted diseases.

[11]  L. Newman,et al.  A Road Map for the Global Elimination of Congenital Syphilis , 2010, Obstetrics and gynecology international.

[12]  R. Steen,et al.  The prevention and management of congenital syphilis: an overview and recommendations. , 2004, Bulletin of the World Health Organization.