title: Impact of on-site testing for maternal syphilis on treatment delays, treatment rates, and perinatal mortality in rural South Africa: a randomised controlled trial.
abstract: BACKGROUND
  Syphilis remains a significant cause of preventable perinatal death in developing countries, with many women remaining untested and thus untreated. Syphilis testing in the clinic (on-site testing) may be a useful strategy to overcome this. We studied the impact of on-site syphilis testing on treatment delays and rates, and perinatal mortality.
  
  
  METHODS
  We conducted a cluster randomised controlled trial among seven pairs of primary healthcare clinics in rural South Africa, comparing on-site testing complemented by laboratory confirmation versus laboratory testing alone. Intervention clinics used the on-site test conducted by primary care nurses, with results and treatment available within an hour. Control clinics sent blood samples to the provincial laboratory, with results returned 2 weeks later.
  
  
  RESULTS
  Of 7134 women seeking antenatal care with available test results, 793 (11.1%) tested positive for syphilis. Women at intervention clinics completed treatment 16 days sooner on average (95% confidence interval: 11 to 21), though there was no significant difference in the proportion receiving adequate treatment at intervention (64%) and control (69%) clinics. There was also no significant difference in the proportion experiencing perinatal loss (3.3% v 5.1%; adjusted risk difference: -0.9%; 95% CI -4.4 to 2.7).
  
  
  CONCLUSIONS
  Despite reducing treatment delays, the addition of on-site syphilis testing to existing laboratory testing services did not lead to higher treatment rates or reduce perinatal mortality. However on-site testing for syphilis may remain an important option for improving antenatal care in settings where laboratory facilities are not available.
authors.affiliation: School of Public Health and Primary Health Care, University of Cape Town, and HIV Prevention and Vaccine Research Unit, Medical Research Council, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Myer
authors.forename: D
authors.initials: D
authors.lastname: Wilkinson
authors.forename: C
authors.initials: C
authors.lastname: Lombard
authors.forename: K
authors.initials: K
authors.lastname: Zuma
authors.forename: K
authors.initials: K
authors.lastname: Rotchford
authors.forename: S S Abdool
authors.initials: SS
authors.lastname: Karim
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D019095:Point-of-Care Systems; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods / Q000592:standards; D011296:Prenatal Diagnosis / Q000379:methods / Q000592:standards; D012307:Risk Factors; D012423:Rural Health; D013019:South Africa / Q000453:epidemiology; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D013588:Syphilis Serodiagnosis / Q000379:methods