title: Introduction of Syphilis Point-of-Care Tests, from Pilot Study to National Programme Implementation in Zambia: A Qualitative Study of Healthcare Workers' Perspectives on Testing, Training and Quality Assurance.
abstract: Syphilis affects 1.4 million pregnant women globally each year. Maternal syphilis causes congenital syphilis in over half of affected pregnancies, leading to early foetal loss, pregnancy complications, stillbirth and neonatal death. Syphilis is under-diagnosed in pregnant women. Point-of-care rapid syphilis tests (RST) allow for same-day treatment and address logistical barriers to testing encountered with standard Rapid Plasma Reagin testing. Recent literature emphasises successful introduction of new health technologies requires healthcare worker (HCW) acceptance, effective training, quality monitoring and robust health systems. Following a successful pilot, the Zambian Ministry of Health (MoH) adopted RST into policy, integrating them into prevention of mother-to-child transmission of HIV clinics in four underserved Zambian districts. We compare HCW experiences, including challenges encountered in scaling up from a highly supported NGO-led pilot to a large-scale MoH-led national programme. Questionnaires were administered through structured interviews of 16 HCWs in two pilot districts and 24 HCWs in two different rollout districts. Supplementary data were gathered via stakeholder interviews, clinic registers and supervisory visits. Using a conceptual framework adapted from health technology literature, we explored RST acceptance and usability. Quantitative data were analysed using descriptive statistics. Key themes in qualitative data were explored using template analysis. Overall, HCWs accepted RST as learnable, suitable, effective tools to improve antenatal services, which were usable in diverse clinical settings. Changes in training, supervision and quality monitoring models between pilot and rollout may have influenced rollout HCW acceptance and compromised testing quality. While quality monitoring was integrated into national policy and training, implementation was limited during rollout despite financial support and mentorship. We illustrate that new health technology pilot research can rapidly translate into policy change and scale-up. However, training, supervision and quality assurance models should be reviewed and strengthened as rollout of the Zambian RST programme continues.
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Éimhín M
authors.initials: ÉM
authors.lastname: Ansbro
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Gill
authors.affiliation: Department of Social & Environmental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Joanna
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Department of Epidemiology and Biostatistics, George Washington University, Washington, District of Columbia, United States of America.
authors.forename: Katharine D
authors.initials: KD
authors.lastname: Shelley
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Lusaka, Zambia.
authors.forename: Susan
authors.initials: S
authors.lastname: Strasser
authors.affiliation: Office of Population and Reproductive Health, United States Agency for International Development, Washington, District of Columbia, United States of America.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Sripipatana
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Lusaka, Zambia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tshaka Ncube
authors.affiliation: HIV/AIDS STI Programme, Ministry of Health, Lusaka, Zambia.
authors.forename: Grace
authors.initials: G
authors.lastname: Tembo Mumba
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Fern
authors.initials: F
authors.lastname: Terris-Prestholt
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Rosanna W
authors.initials: RW
authors.lastname: Peeling
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Mabey
mesh_terms: D001291:Attitude of Health Personnel; D006282:Health Personnel / Q000193:education*; D006284:Health Plan Implementation; D006801:Humans; D010865:Pilot Projects; D019095:Point-of-Care Systems / Q000592:standards*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D013587:Syphilis / Q000175:diagnosis*; D015024:Zambia