title: Syphilis testing in antenatal care: Policies and practices among laboratories in the Americas.
abstract: OBJECTIVE
  To asses laboratory syphilis testing policies and practices among laboratories in the Americas.
  
  
  METHODS
  Laboratory directors or designees from PAHO member countries were invited to participate in a structured, electronically-delivered survey between March and August, 2014. Data on syphilis tests, algorithms, and quality control (QC) practices were analyzed, focusing on laboratories receiving specimens from antenatal clinics (ANCs).
  
  
  RESULTS
  Surveys were completed by 69 laboratories representing 30 (86%) countries. Participating laboratories included 36 (52%) national or regional reference labs and 33 (48%) lower-level laboratories. Most (94%) were public sector facilities and 71% reported existence of a national algorithm for syphilis testing in pregnancy, usually involving both treponemal and non-treponemal testing (72%). Less than half (41%) used rapid syphilis tests (RSTs); and only seven laboratories representing five countries reported RSTs were included in the national algorithm for pregnant women. Most (83%) laboratories serving ANCs reported using some type of QC system; 68% of laboratories reported participation in external QC. Only 36% of laboratories reported data to national/local surveillance. Half of all laboratories serving ANC settings reported a stockout of one or more essential supplies during the previous year (median duration, 30days).
  
  
  CONCLUSIONS
  Updating laboratory algorithms, improving testing standards, integrating data into existing surveillance, and improved procurement and distribution of commodities may be needed to ensure elimination of MTCT of syphilis in the Americas.
authors.affiliation: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Minh
authors.initials: M
authors.lastname: Luu
authors.affiliation: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Cal
authors.initials: C
authors.lastname: Ham
authors.affiliation: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Kamb
authors.affiliation: Communicable Diseases and Health Analysis Department, HIV, Hepatitis, Tuberculosis and Sexually Transmitted Infections Unit, Pan American Health Organization, Washington DC, USA.
authors.forename: Sonja
authors.initials: S
authors.lastname: Caffe
authors.affiliation: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Hoover
authors.affiliation: Communicable Diseases and Health Analysis Department, HIV, Hepatitis, Tuberculosis and Sexually Transmitted Infections Unit, Pan American Health Organization, Washington DC, USA. Electronic address: perezf@paho.org.
authors.forename: Freddy
authors.initials: F
authors.lastname: Perez
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards; D000569:Americas; D005260:Female; D006801:Humans; D007753:Laboratories / Q000592:standards*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011295:Prenatal Care / Q000592:standards; D011296:Prenatal Diagnosis / Q000379:methods / Q000592:standards*; D011786:Quality Control; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000175:diagnosis*; D013588:Syphilis Serodiagnosis / Q000379:methods / Q000592:standards*
keywords: Americas region; Antenatal care; Congenital syphilis; Rapid testing; Syphilis testing