title: Lessons learned from integrating simultaneous triple point-of-care screening for syphilis, hepatitis B, and HIV in prenatal services through rural outreach teams in Guatemala.
abstract: Mother-to-child-transmission of HIV, syphilis, and hepatitis B virus (HBV) remains a challenge in Guatemala, especially in rural regions. A triple antenatal screening program for these infections using point-of-care (POC) testing offered through outreach teams was implemented in the municipality of Puerto de San José. One year following program implementation, antenatal care coverage increased to 99.6% (32.5% increase, P<0.001), testing uptake increased to 50.3% for HIV and syphilis (143.9% (P<0.001) and 1.3% (P=0.89) increase, respectively), and HBV testing increased from 0 to 42.2%. Lessons learned showed that, despite the expansion of triple antenatal POC screening in rural Guatemala, a shortage of healthcare workers and poor supply chain management limited screening uptake. Moreover, training is essential to help health workers overcome their fear of communicating positive results and improve partner notification. Engagement of community health workers was essential to build local capacity and facilitate community acceptance.
authors.affiliation: Fundació Sida i Societat, Escuintla, Guatemala.
authors.forename: Adriana
authors.initials: A
authors.lastname: Smith
authors.affiliation: TransLab, Department of Medical Sciences, Universitat de Girona, Girona, Catalonia, Spain; Fundació Sida i Societat, Barcelona, Catalonia, Spain. Electronic address: xellsabido@gmail.com.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Sabidó
authors.affiliation: Fundació Sida i Societat, Escuintla, Guatemala.
authors.forename: Elsy
authors.initials: E
authors.lastname: Camey
authors.affiliation: Escuintla Health Department, Guatemalan Ministry of Health and Social Assistance, Escuintla, Guatemala.
authors.forename: Anabelle
authors.initials: A
authors.lastname: Batres
authors.affiliation: Fundació Sida i Societat, Barcelona, Catalonia, Spain; Center for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT), Institut Català d´Oncologia/Health Department, Generalitat de Catalunya, Badalona, Catalonia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Casabona
mesh_terms: D000293:Adolescent; D000328:Adult; D003159:Community-Institutional Relations; D005260:Female; D006166:Guatemala; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission; D006509:Hepatitis B / Q000175:diagnosis / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000276:immunology; D011295:Prenatal Care / Q000379:methods; D011296:Prenatal Diagnosis / Q000379:methods / Q000706:statistics & numerical data*; D015397:Program Evaluation / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D013587:Syphilis / Q000175:diagnosis / Q000635:transmission; D055815:Young Adult
keywords: HIV; Hepatitis B; Point-of-care testing; Pregnancy; Syphilis