title: Rapid-Testing Technology and Systems Improvement for the Elimination of Congenital Syphilis in Haiti: Overcoming the "Technology to Systems Gap".
abstract: Background. Despite the availability of rapid diagnostic tests and inexpensive treatment for pregnant women, maternal-child syphilis transmission remains a leading cause of perinatal morbidity and mortality in developing countries. In Haiti, more than 3000 babies are born with congenital syphilis annually. Methods and Findings. From 2007 to 2011, we used a sequential time series, multi-intervention study design in fourteen clinics throughout Haiti to improve syphilis testing and treatment in pregnancy. The two primary interventions were the introduction of a rapid point-of-care syphilis test and systems strengthening based on quality improvement (QI) methods. Syphilis testing increased from 91.5% prediagnostic test to 95.9% after (P < 0.001) and further increased to 96.8% (P < 0.001) after the QI intervention. Despite high rates of testing across all time periods, syphilis treatment lagged behind and only increased from 70.3% to 74.7% after the introduction of rapid tests (P = 0.27), but it improved significantly from 70.2% to 84.3% (P < 0.001) after the systems strengthening QI intervention. Conclusion. Both point-of-care diagnostic testing and health systems-based quality improvement interventions can improve the delivery of specific evidence-based healthcare interventions to prevent congenital syphilis at scale in Haiti. Improved treatment rates for syphilis were seen only after the use of systems-based quality improvement approaches.
authors: GHESKIO Centres, Port-Au-Prince, Haiti.
authors: Linda
authors: 0000-0002-3240-1680
authors: L
authors: Severe
authors: GHESKIO Centres, Port-Au-Prince, Haiti.
authors: Daphne
authors: D
authors: Benoit
authors: Department of Public Health, Weill Cornell Medical Center, New York, NY, USA.
authors: Xi K
authors: XK
authors: Zhou
authors: GHESKIO Centres, Port-Au-Prince, Haiti ; Global Health Center, Weill Cornell Medical Center, New York, NY, USA.
authors: Jean W
authors: JW
authors: Pape
authors: London School of Tropical Medicine, London, UK.
authors: Rosanna W
authors: RW
authors: Peeling
authors: GHESKIO Centres, Port-Au-Prince, Haiti ; Global Health Center, Weill Cornell Medical Center, New York, NY, USA.
authors: Daniel W
authors: DW
authors: Fitzgerald
authors: Department of Medicine, Weill Cornell Medical Center, 525 East 68th Street, P.O. Box 130, New York, NY 10065, USA ; Institute for Healthcare Improvement, Cambridge, MA, USA.
authors: Kedar S
authors: KS
authors: Mate