We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into routine antenatal clinic (ANC) services in two rural districts in Nyanza Province, Kenya. In February 2011, nurses from 25 clinics were trained in using RSTs and documenting test results and treatment. During March 2011–February 2012, free RSTs and treatment kits were provided to clinics for use during ANC visits. We analyzed ANC registry data from eight clinics during the 12-month periods before and during RST program implementation and compared syphilis testing, diagnosis, and treatment during the two periods. Syphilis testing at first ANC visit increased from 18% (279 of 1,586 attendees) before the intervention to 70% (1,123 of 1,614 attendees) during the intervention ( ); 35 women (3%) tested positive during the intervention period compared with 1 (<1%) before ( ). Syphilis treatment was not recorded according to training recommendations; seven clinics identified 28 RST-positive women and recorded 34 treatment kits as used. Individual-level data from three high-volume clinics supported that the intervention did not negatively affect HIV test uptake. Integrating RSTs into rural ANC services increased syphilis testing and detection. Record keeping on treatment of syphilis in RST-positive women remains challenging. 1. Introduction The World Health Organization (WHO) estimated that globally in 2008 1.4 million women had syphilis in pregnancy, causing approximately 520,000 adverse pregnancy outcomes including 305,000 perinatal deaths [1]. Untreated maternal syphilis currently equals or exceeds HIV, neonatal tetanus, or malaria as a cause of perinatal mortality [2]. Caused by the bacterium Treponema pallidum, syphilis is efficiently transmitted in utero to the fetus [3, 4]. When left untreated, adverse pregnancy outcomes can occur in up to 80% of affected pregnancies [4], with the most severe outcomes occurring in women with early (i.e., primary, secondary, or early latent) infections [3]. A recent meta-analysis adjusting for other causes of mortality estimated that, among asymptomatic women, untreated maternal syphilis caused stillbirth in 21% and neonatal death in 9% of affected pregnancies and led to low birth weight in 6% and congenital infection in 15% of surviving infants [5]. Infants born with syphilis may suffer disfigurement, delayed development, or other complications [3]. Early detection and adequate treatment (i.e., long-acting intramuscular penicillin) prevent poor outcomes due to mother-to-child transmission (MTCT) of syphilis [3, 4]. Nyanza
References
[1]
L. Newman, M. Kamb, S. Hawkes et al., “Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data,” PLOS Medicine, vol. 8, no. 2, Article ID e56463, 2013.
[2]
M. L. Kamb, L. M. Newman, P. L. Riley, S. J. Hawkes, T. Malik, and N. J. Broutet, “A road map for the global elimination of congenital syphilis,” Obstetrics and Gynecology International, vol. 2010, Article ID 312798, 6 pages, 2010.
[3]
S. M. Berman, “Maternal syphilis: pathophysiology and treatment,” Bulletin of the World Health Organization, vol. 82, no. 6, pp. 433–438, 2004.
[4]
World Health Organization, The Global Elimination of Congenital Syphilis: Rationale and Strategy for Action 2007, WHO Press, Geneva, Switzerland, 2007, http://whqlibdoc.who.int/publications/2007/9789241595858_eng.pdf.
[5]
G. B. Gomez, M. L. Kamb, L. M. Newman, J. Mark, N. Broutet, and S. J. Hawkes, “Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis,” Bulletin of the World Health Organization, vol. 91, pp. 217–226, 2013.
[6]
Kenya National Bureau of Statistics (KNBS) and ICF Macro, Kenya Demographic and Health Survey 2008-09, KNBS and ICF Macro, Calverton, Md, USA, 2010, http://www.measuredhs.com/pubs/pdf/fr229/fr229.pdf.
[7]
World Health Organization, Neonatal and Perinatal Mortality: Country, Regional and Global Estimates, WHO Press, Geneva, Switzerland, 2006, http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf.
[8]
National AIDS and STI Control Programme, Ministry of Health, Kenya AIDS Indicator Survey, 2007, Ministry of Health, Nairobi, Kenya, 2009, http://www.nascop.or.ke/library/3d/Official_KAIS_Report_20091.pdf.
[9]
F. Terris-Prestholt, D. Watson-Jones, K. Mugeye et al., “Is antenatal syphilis screening still cost effective in sub-Saharan Africa,” Sexually Transmitted Infections, vol. 79, no. 5, pp. 375–381, 2003.
[10]
World Health Organization, Packages of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and Child Health, WHO Press, Geneva, Switzerland, 2010, http://whqlibdoc.who.int/hq/2010/WHO_FCH_10.06_eng.pdf.
[11]
K. A. O’Connor, I. Sadumah, S. Kola et al., “The impact of targeted incentives and enhanced services on use of maternal health services in rural Western Kenya,” in Proceedings of the 61st Annual Epidemic Intelligence Service Conference (EIS '12), p. 18, Atlanta, Ga, USA, April 2012.
[12]
M. B. Miles and A. M. Huberman, “Data management and analysis methods,” in Handbook of Qualitative Research, N. K. Denzin and Y. S. Lincoln, Eds., pp. 428–444, Sage Publications, Thousand Oaks, Calif, USA, 1994.
[13]
R. O. Swai, G. R. Somi, M. I. N. Matee et al., “Surveillance of HIV and syphilis infections among antenatal clinic attendees in Tanzania-2003/2004,” BMC Public Health, vol. 6, article 91, 2006.
[14]
S. Strasser, E. Bitarakwate, M. Gill, et al., “Introduction of rapid syphilis testing within prevention of mother-to-child transmission of HIV programs in Uganda and Zambia: a field acceptability and feasibility study,” Journal of Acquired Immune Deficiency Syndromes, vol. 61, no. 3, pp. e40–e46, 2012.
[15]
World Health Organization, Field Safety Notice No. 1, 2011, http://www.who.int/diagnostics_laboratory/procurement/111201_productalert_for_product0027_mx012.pdf.
[16]
Humanitarian News and Analysis, “KENYA: new guidelines follow recall of faulty HIV test,” IRIN, January 2012, http://www.plusnews.org/PrintReport.aspx?ReportID=94586.
[17]
R. Byamugisha, A. N. Str？m, G. Ndeezi, C. A. S. Karamagi, T. Tyllesk？r, and J. K. Tumwine, “Male partner antenatal attendance and HIV testing in eastern Uganda: a randomized facility-based intervention trial,” Journal of the International AIDS Society, vol. 14, no. 1, article 43, 2011.
[18]
D. A. Katz, J. N. Kiarie, G. C. John-Stewart, B. A. Richardson, F. N. John, and C. Farquhar, “Male perspectives on incorporating men into antenatal HIV counseling and testing,” PLoS ONE, vol. 4, no. 11, Article ID e7602, 2009.
