title: Integration of antenatal syphilis screening in an urban HIV clinic: a feasibility study.
abstract: BACKGROUND
  Syphilis infection during pregnancy leads to avoidable morbidity and mortality and remains a significant problem in sub-Saharan Africa. Despite global initiatives to increase the proportion of pregnant women screened, implementation has been slow. We sought to investigate the feasibility of adding syphilis screening within an integrated antenatal HIV clinic.
  
  
  METHODS
  Pregnant women attending the HIV antenatal clinic were sequentially enrolled and consenting participants answered a questionnaire on sexual behavior and previous pregnancies, provided sociodemographic data, and were tested using rapid plasmin reagin (RPR). If positive, participants were treated with benzathine penicillin. All were given a partner notification slip and were followed up after delivery to determine birth outcomes.
  
  
  RESULTS
  584 of 606 (95.7%) women approached and consented to test for syphilis. 570 women were enrolled (median age 29 (IQR 25-32) with a median (IQR) CD4 of 372 (257-569) cells/μL). Of the 5.1% (29/570) with a positive RPR, all were asymptomatic, were successfully contacted, and treated with benzathine penicillin without adverse reactions. Overall, 61 (12.1%) of the participants had an adverse birth outcome. In the bivariate analysis, only age was significantly different between those with and without a positive RPR (RR = 1.15, 95% CI 1.065-1.248; p < 0.001). Partners of only 10 (34.5%) participants returned for treatment.
  
  
  CONCLUSIONS
  Structural interventions such as opt-out testing for syphilis within integrated HIV-antenatal care clinics are feasible and capitalize on the excellent care programs that have already been established for HIV care. Novel approaches are required for partner notification.
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda. ymanabe@jhmi.edu.|Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA. ymanabe@jhmi.edu.
authors.forename: Yukari C
authors.initials: YC
authors.lastname: Manabe
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda. namaleg2002@yahoo.com.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Namale
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda. enalintya@yahoo.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nalintya
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda. jbsempa@yahoo.co.uk.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sempa
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda. rratanshi@idi.co.ug.
authors.forename: Rosalind Parkes
authors.initials: RP
authors.lastname: Ratanshi
authors.affiliation: Amsterdam Institute for Global Health and Development, Amsterdam Medical Center, Amsterdam, Netherlands. n.pakker@aighd.org.
authors.forename: Nadine
authors.initials: N
authors.lastname: Pakker
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda. katabira@imul.com.|Department of Medicine, Makerere College of Health Sciences, Kampala, Uganda. katabira@imul.com.
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D016358:Contact Tracing; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections; D006801:Humans; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D019037:Urban Health Services; D055815:Young Adult
chemical_list: D010401:Penicillin G Benzathine