title: Introduction of rapid syphilis testing within prevention of mother-to-child transmission of HIV programs in Uganda and Zambia: a field acceptability and feasibility study.
abstract: BACKGROUND
  Given that integration of syphilis testing into prevention of mother-to-child transmission of HIV (PMTCT) programs can prevent adverse pregnancy outcomes, this study assessed feasibility and acceptability of introducing rapid syphilis testing (RST) into PMTCT services.
  
  
  METHODS
  RST was introduced into PMTCT programs in Zambia and Uganda. Using a pre-post intervention design, HIV and syphilis testing and treatment rates during the intervention were compared with baseline.
  
  
  RESULTS
  In Zambia, comparing baseline and intervention, 12,761 of 15,967 (79.9%) and 11,460 of 11,985 (95.6%) first-time antenatal care (ANC) attendees were tested for syphilis (P < 0.0001), 523 of 12,761 (4.1%) and 1050 of 11,460 (9.2%) women tested positive (P < 0.0001); and 267 of 523 (51.1%) and 1000 of 1050 (95.2%) syphilis-positive women were treated (P < 0.0001), respectively. Comparing baseline and intervention, 7479 of 7830 (95.5%) and 11,151 of 11,409 (97.7%) of ANC attendees were tested for HIV (P < 0.0001) and 1303 of 1326 (98.3%) and 2036 of 2034 (100.1%) of those testing positive received combination antiretroviral drugs or single-dose nevirapine prophylaxis (P < 0.0001). In Uganda, 13,131 of 14,540 (90.3%) women were tested for syphilis during intervention, with 690 of 13,131 (5.3%) positive and 715 of 690 (103.6%) treated. Syphilis baseline data were collected, but not included in analysis, as ANC syphilis testing before the study was not consistently practiced. Comparing baseline and intervention, 6479 of 6776 (95.6%) and 11,192 of 11,610 (96.4%) ANC attendees were tested for HIV (P = 0.0009) and 570 of 726 (78.5%) and 964 of 1153 (83.6%) received combination or single-dose prophylaxis (P = 0.007). In Zambia, 254 of 1050 (24.2%) syphilis-positive pregnant women were HIV-positive and 99 of 690 (14.3%) in Uganda.
  
  
  CONCLUSIONS
  Integrating RST in PMTCT programs increases screening and treatment for syphilis among HIV-positive pregnant women and does not compromise HIV services.
authors: Elizabeth Glaser Pediatric AIDS Foundation, Lusaka, Zambia. sstrasser@pedaids.org
authors: Susan
authors: S
authors: Strasser
authors: Edward
authors: E
authors: Bitarakwate
authors: Michelle
authors: M
authors: Gill
authors: Heather J
authors: HJ
authors: Hoffman
authors: Othiniel
authors: O
authors: Musana
authors: Anne
authors: A
authors: Phiri
authors: Katharine D
authors: KD
authors: Shelley
authors: Tabitha
authors: T
authors: Sripipatana
authors: Alexander Tshaka
authors: AT
authors: Ncube
authors: Namwinga
authors: N
authors: Chintu
mesh_terms: D060085:Coinfection / Q000175:diagnosis / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D012680:Sensitivity and Specificity; D013587:Syphilis / Q000175:diagnosis / Q000517:prevention & control; D013588:Syphilis Serodiagnosis / Q000379:methods*; D014454:Uganda / Q000453:epidemiology; D015024:Zambia / Q000453:epidemiology