title: Audit of antenatal screening for syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study.
abstract: OBJECTIVE
  The antenatal prevalence of syphilis and HIV/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in the same population and reassess the trends in HIV rates.
  
  
  METHODS
  From August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border.
  
  
  RESULTS
  Seroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13/2,123). The three active (VDRL≥1:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (>75% were < 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors.
  
  
  CONCLUSIONS
  As HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies.
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand ; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand ; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK.
authors.forename: Rose
authors.initials: R
authors.lastname: McGready
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.
authors.forename: Joy
authors.initials: J
authors.lastname: Kang
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.
authors.forename: Isabella
authors.initials: I
authors.lastname: Watts
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.
authors.forename: Mary Ellen G
authors.initials: ME
authors.lastname: Tyrosvoutis
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.
authors.forename: Miriam B
authors.initials: MB
authors.lastname: Torchinsky
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.
authors.forename: Aung Myo
authors.initials: AM
authors.lastname: Htut
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.
authors.forename: Nay Win
authors.initials: NW
authors.lastname: Tun
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.
authors.forename: Lily
authors.initials: L
authors.lastname: Keereecharoen
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.
authors.forename: Chirapat
authors.initials: C
authors.lastname: Wangsing
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.
authors.forename: Borimas
authors.initials: B
authors.lastname: Hanboonkunupakarn
authors.affiliation: Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand ; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand ; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK.
authors.forename: François H
authors.initials: FH
authors.lastname: Nosten
keywords: HIV syphilis pregnancy yaws refugees migrants Myanmar