title: Improving the screening of blood donors with syphilis rapid diagnostic test (RDT) and rapid plasma reagin (RPR) in low- and middle-income countries (LMIC).
abstract: BACKGROUND
  Syphilis testing conventionally relies on a combination of non-treponemal and treponemal tests. The primary objective of this study was to describe the positive predictive value (PPV) of a screening algorithm in a combination of a treponemal rapid diagnostic test (RDT) and rapid plasma reagin (RPR) test at Komfo Anokye Teaching Hospital (KATH), Ghana.
  
  
  METHODS
  From February 2014 to January 2015, 5 mL of venous blood samples were taken from 16 016 blood donors and tested with a treponemal RDT; 5 mL of venous blood was taken from 526 consenting initial syphilis sero-reactive blood donors. These RDT reactive samples were confirmed with an algorithm, applying the Vitros®/Abbott-Architect®algorithm as gold standard.
  
  
  RESULTS
  A total of 478 of 526 RDT reactive donors were confirmed positive for syphilis, making a PPV of 90·9%. Of the 172 (32·7%) donors who were also RPR positive, 167 were confirmed, resulting in a PPV of 97·1%. The PPV of the combined RDT and RPR (suspected active syphilis) testing algorithm was highest among donors at an enhanced risk of syphilis, family/replacement donors (99·9%), and among voluntary donors above 25 years (98·6%).
  
  
  CONCLUSIONS
  Screening of blood donors by combining syphilis RDT and RPR with relatively good PPV may provide a reasonable technology for LMIC that has a limited capacity for testing and can contribute to the improvement of blood safety with a minimal loss of donors.
authors.affiliation: Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.|Faculty of Health and Life Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: F
authors.initials: F
authors.lastname: Sarkodie
authors.affiliation: Faculty of Health and Life Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: O
authors.initials: O
authors.lastname: Hassall
authors.affiliation: School of Public Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.|Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: E
authors.initials: E
authors.lastname: Owusu-Dabo
authors.affiliation: Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: S
authors.initials: S
authors.lastname: Owusu-Ofori
authors.affiliation: Faculty of Health and Life Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: I
authors.initials: I
authors.lastname: Bates
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: I C
authors.initials: IC
authors.lastname: Bygbjerg
authors.affiliation: Department of Clinical Microbiology Kumasi, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: A
authors.initials: A
authors.lastname: Owusu-Ofori
authors.affiliation: Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: L H
authors.initials: LH
authors.lastname: Harritshøj
authors.affiliation: Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Ullum
mesh_terms: D000328:Adult; D000465:Algorithms; D000907:Antibodies, Bacterial / Q000097:blood*; D001782:Blood Donors; D003430:Cross-Sectional Studies; D003906:Developing Countries; D046148:Donor Selection / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D005260:Female; D005869:Ghana; D006801:Humans; D008297:Male; D008875:Middle Aged; D013587:Syphilis / Q000097:blood*; D013588:Syphilis Serodiagnosis / Q000379:methods* / Q000592:standards
chemical_list: D000907:Antibodies, Bacterial
keywords: blood donors; blood safety; public health; rapid diagnostic test; rapid plasma reagin