Syphilis and HIV co-infection in patients who attend an AIDS outpatient clinic in Vitoria, Brazil

Diagnostic performance of two rapid tests for syphilis screening in people living with HIV in Cali, Colombia

INTRODUCTION

There is insufficient evidence supporting the use of rapid diagnostic tests (RDTs) for syphilis in people living with HIV (PLWH). We evaluated the diagnostic performance of two commercially available RDTs (Bioline and Determine) in PLWH in Cali, Colombia.

METHODS

A cross-sectional field validation study on consecutive adults with confirmed HIV diagnosis attending three outpatient clinics. Both RDTs were performed on capillary blood (CB), obtained by finger prick, and sera, by venipuncture. A combination of treponemal enzyme linked immunosorbent assay (ELISA) and Treponema pallidum haemagglutination assay (TPHA) on serum samples was the reference standard. Rapid plasma reagin (RPR) and clinical criteria were added to define active syphilis. Sensitivity and specificity, predictive values and likelihood ratios (LR) of RDTs were estimated with their corresponding 95% confidence interval (95% CI). Stratified analyses by sample type, patient characteristics, non-treponemal titers, operator and re-training were performed.

RESULTS

244 PLWH were enrolled, of whom 112 (46%) had positive treponemal reference tests and 26/234 (11.1%) had active syphilis. The sensitivities of Bioline on CB and sera were similar (96.4% vs 94.6%, p = 0.6). In contrast, Determine had a lower sensitivity on CB than sera (87.5% vs 99.1%, p<0.001). Sensitivities were lower in PLWH not receiving ART (Bioline 87.1% and Determine 64.5%, p<0.001) and for one of the operators (Bioline 85% and Determine 60%, p<0.001). Specificities of the RDTs were > 95% in most analyses. Predictive values were 90% or higher. For active syphilis, the RDTs showed a similar performance pattern but with decreased specificities.

CONCLUSION

The studied RDTs have an excellent performance in PLWH to screen for syphilis and potentially for active syphilis, yet Determine performs better on sera than CB. Patient characteristics and potential difficulties operators may face in acquiring enough blood volume from finger pricks should be considered for the implementation and the interpretation of RDTs.

High Incidence, Reinfections, and Active Syphilis in Populations Attending a Specialized HIV Clinic in Mexico, a Dynamic Cohort Study

Syphilis, a sexually transmitted infection, has reemerged in many vulnerable groups around the world. The objective of the current study was to determine the prevalence and incidence of syphilis among people who attended a specialized HIV clinic in Mexico from 2011 to 2015. Databases from the laboratory were analyzed, and the following four groups were formed: people seeking HIV-1 voluntary counseling and testing (VCT), people in prison (PPr), people living with HIV (PLWH), and patients from primary care clinics (others). The diagnosis of syphilis was made using the reverse algorithm; antibody titers were examined to determine the stage of infection. Baseline data were analyzed and, with follow-up information, a retrospective dynamic cohort was formed. Factors associated with the seroprevalence of syphilis and active syphilis were evaluated by the chi-square test. Moreover, risk factors for the incidence of syphilis were described. A total of 81,863 baseline individuals were analyzed. The seroprevalence of syphilis was 9.9% in the VCT group, 8.2% in the PPr group, 37.0% in the PLWH group, and 8.7% in the others group; the prevalence of active syphilis was 1.7-13.1%. A total of 11,124 people were followed up. The incidence (cases per 100 person-years) was 3.5 among the VCT group, 16.0 among the PLWH group, and < 0.1 among both the PPr and others groups, respectively; moreover, the frequency of reinfections was 11.1-24.4%. The high prevalence and incidence of syphilis, active syphilis, and reinfections among men, transgender people, individuals aged 20-39 years, and people with a history of HIV or hepatitis B suggest that it is critical to improve prevention, diagnosis, and treatment measures to stop the reemergence of syphilis. There are also new factors such as methamphetamine use, group sex, or contacting partners over the internet that are associated with syphilis. In addition, HIV preexposure prophylaxis could contribute to the increased incidence of syphilis by providing false security in the prevention of STIs, thereby increasing risky sexual behaviors.

Prevalence and Factors Associated With Syphilis in People Living With HIV/AIDS in the State of Pará, Northern Brazil

Syphilis continues to be a public health problem worldwide and its incidence has increased in people living with HIV/AIDS in recent years. This study determined the prevalence and factors associated with syphilis in people living with HIV/AIDS in the city of Belém, northern Brazil. A cross-sectional study was conducted from June to November 2018. A total of 500 people living with HIV/AIDS attended at a specialized unit of the public health network of the State of Pará were studied. Questionnaires were used to collect socio-demographic data and potential risk factors for syphilis. Blood samples were collected from all subjects and screened for syphilis using VDRL, and the seropositive were confirmed using FTA-abs. Logistic regressions were used to identify the factors associated with syphilis. Most subjects were male (56.8%), had more than 40 years (54.0%), single (63.0%), had finished high school (54.2%), had monthly income ≤1 minimum wage (72.4%), and had been born to the city of Belém (59.8%). Prevalence of syphilis was 6.4%. Eight characteristics/behaviors associated with syphilis: male, young adults, single, studied at least high school, monthly income >1 minimum wage, homosexual/bisexual, does not use or sporadically use condoms during sexual intercourse, and have had more than one sexual partner in the last three months. The prevalence of syphilis in people living with HIV/AIDS in Belém is low when compared to other Brazilian states. However, there is a need for public policies and actions to monitor, control and prevent these two sexually transmitted infections.

Syphilis among adult males with a history of male-to-male sexual contact living with diagnosed HIV in New York State (excluding New York City): The challenge of intersecting epidemics

Since 2009, syphilis has been increasing in New York State (NYS) excluding New York City (NYC) among men with a history of male-to-male sexual contact (MSM). Because MSM make up a disproportionate number of new HIV infections, this study aims to: 1) establish yearly rates of early syphilis diagnosis, 2) assess factors associated with early syphilis diagnosis, and 3) describe missed opportunities for earlier diagnosis of syphilis among MSM living with diagnosed HIV(MSMLWDH) in NYS, excluding NYC. A cohort of adult MSMLWDH alive in 2013 were followed through 2016 to identify individuals with at least one early syphilis diagnosis between July 2014 and December 2016. Early syphilis diagnosis rates were calculated for 2015 and 2016. Crude relative risks and 95% confidence intervals were calculated to determine associations between available covariates and both syphilis diagnosis and missed opportunities. Missed opportunities were defined as reports of an HIV-related laboratory test within a given window corresponding to syphilis staging where syphilis testing was not performed at the same time. Of 7,512 MSMLWDH, 50.0% were non-Hispanic white, 85.4% aged ≥35, and 320(4.3%) had an early syphilis diagnosis. Yearly rates were: 1,838/100,000, and 1,681/100,000 in 2015 and 2016, respectively. Persons who were non-Hispanic black, living with diagnosed HIV for less than three years, aged <45, and were always virally suppressed or always in HIV care were significantly more likely to have a syphilis diagnosis. Over half of individuals had evidence of a missed opportunity for earlier syphilis diagnosis. Syphilis stage at diagnosis, older age, and syphilis diagnosis not concurrent with an HIV-related laboratory test were associated with a higher likelihood of having a missed opportunity. This study supports high interrelatedness of the syphilis and HIV epidemics among MSM. Since syphilis can impact HIV viral load suppression status, efforts to end the HIV epidemic need to be coupled with syphilis elimination efforts.

Prevalência de resultados positivos de VDRL (Venereal Disease Research Laboratory) e análise das variáveis epidemiológicas em pacientes atendidos no serviço de saúde pública

A sífilis é uma infecção causada pelo Treponema pallidum de transmissão sexual, sanguínea e vertical. Apesar de ser de fácil diagnóstico e tratamento, sua incidência vem aumentando no Brasil nos últimos anos, sendo considerado um problema de saúde pública no país e no mundo. Este trabalho buscou a conhecer a ocorrência de resultados positivos de VDRL (Venereal Disease Research Laboratory) entre o período de 2014 a 2016 na população atendida nos serviços de saúde da prefeitura de Juiz de Fora/MG, bem como suas características epidemiológicas. Foram analisados 25.735 resultados de VDRL do banco de dados do Laboratório Central (LACEN) da prefeitura de Juiz de Fora. Os resultados reagentes foram então relacionados com as variáveis ano, gênero, idade, gestantes ou não e região da cidade em que se realizou o exame. A prevalência de resultados positivos foi de 5,55%, com maior número de casos registrados em 2015. Os casos reagentes foram mais prevalentes na região central, nos homens e obteve-se maior predomínio para a faixa etária de 12 a 18 anos. No período de agosto de 2015 a dezembro de 2016, entre as mulheres, foi observada uma maior positividade no teste de VDRL em não gestantes. Os dados obtidos nesse estudo apontaram para aumento da prevalência de sífilis entre 2014 e 2015, seguido de uma queda no ano seguinte, entre a população atendida pelo SUS, sendo os homens jovens a população de maior risco. Tais dados podem contribuir para as políticas de saúde pública de prevenção e tratamento da sífilis.

Syphilis prevalence and risk factors among young men presenting to the Brazilian Army in 2016: Results from a national survey

The Conscripts Survey has been conducted periodically by the Brazilian Department of Sexually Transmitted Infections (STIs), AIDS, and Viral Hepatitis (DIAHV) in collaboration with the Brazilian Ministry of Defense for over 2 decades. It aims to assess the syphilis prevalence and obtain data on knowledge regarding STIs and their risk factors among conscripts enlisted for the Brazilian Army.This cross-sectional study was conducted among conscripts across Brazil aged 17 to 22 years from August to December 2016. It included a self-reported questionnaire and blood testing for syphilis, HIV, and hepatitis B and C.In total 38,247 conscripts were enrolled; after exclusion due to a lack of information, 37,282 (93.2%) conscripts were included. The estimated syphilis prevalence rates were: 1.63%, 1.09%, and 0.62% for screened, confirmed, and active syphilis, respectively. Among those with active syphilis, 81.1% reported not having syphilis infection in their lifetime. Higher confirmed syphilis prevalence rates were observed in the South region, followed by North and Southeast regions. Independent factors associated with confirmed syphilis infection were: self-reported STIs in one's lifetime (odds ratio [OR] = 7.24; P < .001), same-sex sexual relationships (OR = 3.43; P = .001), and having the 1st sexual intercourse encounter before 15 years of age (OR = 2.62; P = .04). The proportion of conscripts who reported having sex with other men (MSM) was 4.3%, and the estimated syphilis prevalence in this group was 5.23%, 4.61%, and 3.60% for screened, confirmed, and active syphilis, respectively. The sexual behaviors most frequently associated with confirmed syphilis were: sexual relationship with casual partners in the last year (P < .001), same-sex sexual relationships (P < .001), more than 10 partners (P = .006), and having sexual intercourse before 15 years of age (P = .003). Although not significant, only 25.4% of the conscripts who had a confirmed syphilis reported the use of condoms with steady partners, 32.4% with casual partner, and 24.3% with any partner.We found that syphilis is on the rise among the young Brazilian male population. The increase in its prevalence, particularly among MSM, highlights the need for urgent public health interventions, action plans, and implementation of risk reduction strategies aimed at this population.

High Prevalence of Treponema pallidum Infection in Brazilian Prisoners

The number of new syphilis cases in Brazil has risen alarmingly in recent years. However, there is limited data regarding syphilis prevalence in the Brazilian prison population. To facilitate the development of effective interventions, a cross-sectional study was undertaken to determine the prevalence of Treponema pallidum infection, active syphilis, and associated risk factors among Brazilian prisoners. We administered a questionnaire to a population-based sample of prisoners from 12 prisons in Central-West Brazil and collected sera for syphilis testing, from January to December 2013. Univariable and multivariable regression analyses were performed to assess associations with active syphilis. We recruited 3,363 prisoners (men: 84.6%; women: 15.4%). The overall lifetime and active syphilis prevalences were 10.5% (9.4% among men; 17% among women, P < 0.001) and 3.8% (2% among men; 9% among women, P < 0.001), respectively. The variables associated with active syphilis in men prisoners were homosexual preference, history of sexually transmitted infections, and human immunodeficiency virus status. Among women, the factors were sex with intravenous drug users, genital ulcer disease, and previous incarceration. Despite the high prevalence of active syphilis, 88.5% reported unawareness of their serological status and 67% reported unprotected sexual practices. Women had the highest rates of infection, including them in a high-risk group for the development of syphilis during pregnancy. Thus, implementing screening programs to enable continuous measures of control and prevention of T. pallidum infection in the prison environment, mainly in women institutions, is important to prevent severe forms of this disease and congenital infections.

Prevalence and factors associated with syphilis in a Reference Center

INTRODUCTION:

The implementation of the rapid test (RT) for syphilis increases access of vulnerable populations to early diagnosis and treatment, impacting the outcomes of infection. We aimed to assess the prevalence of and factors associated with syphilis in a Center for Testing and Counseling (CTC).

METHODS:

We conducted a cross-sectional study at a Reference Center for sexually transmitted disease (STD) and acquired immune deficiency syndrome in Londrina, Northern Paraná State, Southern Brazil. Data regarding the 5,509 individuals who underwent RT from June 2012 to December 2014 were collected from patient records and the CTC Information System and served as the basis to check associations of syphilis cases (346) and cases without syphilis (5,163). Nine patients' records were not found. OpenEpi was used to perform a prevalence analysis and determine odds ratios to assess the associations between sociodemographic and behavioral variables (independent variables) and cases of syphilis (dependent variable). An alpha value <0.05 was considered statistically significant.

RESULTS:

The prevalence of syphilis was 6.3%; higher in males (7.5%) than in females (4.3%, p <0.001). Syphilis was associated with an age of 25-34 years, little education, and single marital status. The main associated behavioral factors were men who have sex with men, drug users, STD patients, and those presenting with an STD in the last year. The use of alcohol, marijuana, cocaine, and crack was significantly associated with syphilis.

CONCLUSIONS:

Strategies for prevention and control of syphilis should be intensified, especially in populations identified as most vulnerable.

Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru

BACKGROUND

Syphilis is concentrated among high-risk groups, but the epidemiology of syphilis reinfection is poorly understood. We characterized factors associated with syphilis incidence, including reinfection, in a high-risk cohort in Peru.

METHODS

Participants in the NIMH CPOL trial were assessed at baseline and 2 annual visits with HIV/STI testing and behavioral surveys. Participants diagnosed with syphilis also attended 4- and 9-month visits. All participants underwent syphilis testing with RPR screening and TPPA confirmation. Antibiotic treatment was provided according to CDC guidelines. Reinfection was defined as a 4-fold titer increase or recurrence of seroreactivity after successful treatment with subsequent negative RPR titers. The longitudinal analysis used a Possion generalized estimating equations model with backward selection of variables in the final model (criteria P <0.02).

RESULTS

Of 2,709 participants, 191 (7.05%) were RPR-reactive (median 1:8, range 1:1-1:1024) with TPPA confirmation. There were 119 total cases of incident syphilis, which included both reinfection and first-time incident cases. In the bivariate analysis, the oldest 2 quartiles of age (incidence ratio (IR) 3.84; P <0.001 and IR 8.15; P <0.001) and being MSM/TW (IR 6.48; P <0.001) were associated with higher risk of incident syphilis infection. Of the sexual risk behaviors, older age of sexual debut (IR 12.53; P <0.001), not being in a stable partnership (IR 1.56, P = 0.035), higher number of sex partners (IR 3.01; P <0.001), unprotected sex in the past 3 months (IR 0.56; P = 0.003), HIV infection at baseline (IR 3.98; P <0.001) and incident HIV infection during the study period (IR 6.26; P = 0.003) were all associated with incident syphilis. In the multivariable analysis, older age group (adjusted incidence ratio (aIR) 6.18; P <0.001), men reporting having sex with a man (aIR 4.63; P <0.001), and incident HIV infection (aIR 4.48; P = 0.008) were significantly associated.

CONCLUSIONS

We report a high rate of syphilis reinfection among high-risk men who have evidence of previous syphilis infection. Our findings highlight the close relationship between HIV incidence with both incident syphilis and syphilis reinfection. Further studies on syphilis reinfection are needed to understand patterns of syphilis reinfection and new strategies beyond periodic testing of high-risk individuals based on HIV status are needed.

Syphilis on the rise: A prolonged syphilis outbreak among HIV-infected patients in Northern Greece

INTRODUCTION

Sexually transmitted diseases (STDs) are a major public health issue in Europe. Numerous outbreaks of syphilis have been described recently and an increased prevalence of high-risk sexual practices has raised concern about the transmission of HIV and other STDs. Similarly, an increase in sexually transmitted infections has been recorded in Northern Greece.

METHODS

This report describes a recent outbreak of syphilis in people living with HIV. The demographic, clinical, and serologic data of HIV patients diagnosed with syphilis were recorded and analyzed. Data on syphilis incidence from the general population was also compared to HIV patients' data.

RESULTS

Fifty-eight HIV-patients of the Infectious Diseases Unit of a tertiary hospital (5.2%) were diagnosed with syphilis during a three-year period (2008-2010). Highly active antiretroviral therapy (HAART) and coexistence of other STDs were independent predictors of syphilis (OR: 2.4, 95CI%: 1.26, 4.63, p=0.008; OR: 9.4, 95%CI: 4.49, 19.64, p<0.001, respectively). Origin from a country other than Greece (p=0.005), and homosexual contact (p=0.003), were separate risk factors for syphilis in the general population in the same area.

CONCLUSION

Diagnosis of a sexually transmitted disease in an HIV patient is a crucial clinical event that should trigger the clinician's suspicion for high-risk sexual behavior. Sexual health assessments should be a routine process for HIV patients.

Co-infection assessment in HBV, HCV, and HIV patients in Western Saudi Arabia

To estimate the prevalence of diagnosed and undiagnosed coinfections among HIV, HBV, and HCV infected patients. Retrospective analysis of laboratory records for HIV, HBV, and HCV patients presenting at the HIV outpatient clinic. Serological data including hepatitis B surface antigen (HBsAg), hepatitis B e-antigen (HBeAg), hepatitis B e-antibody (anti-HBe), antibodies to HIV and HCV, anti-toxoplasmosis IgG and IgM antibodies, and anti-syphilis antibodies (VDRL) were collected. We obtained data for 628 (218 HCV, 268 HBV, and 142 HIV) patients. Male-to-female ratios were 1:1 for HCV, 3:4 for HBV, and 5:3 for HIV. Age means (SD) were 54.24 (16.40), 44.53 (18.83), and 40.39 (15.92) years for HCV, HBV, and HIV, respectively. In HIV group, the prevalence of HBV and HCV coinfections was 8.5% and 2.8%, respectively. In HBV group, the prevalence of HCV and HIV coinfections was 1.1% and 1.5%, respectively. In HCV group, HIV or HBV coinfections occurred at the same frequency (1.4%). An absence of screening for coinfections was detected in 7.0-48.5% patients as per the group and the infectious agent; which represents an estimated proportion of 20 out of 1,000 patients with an undiagnosed coinfection. Despite a relatively low prevalence of coinfections, a significant proportion of cases remain undiagnosed because of a lack of systematic screening. J. Med. Virol. 88:1545-1551, 2016. © 2016 Wiley Periodicals, Inc.

Syphilis treatment in the presence of HIV: the debate goes on

PURPOSE OF REVIEW

Benzathine Penicillin G has been used to treat syphilis for over 50 years; however, the precise regimen of penicillin for treatment of syphilis in HIV-positive individuals remains a hot topic of debate. Although international guidelines recommend the same treatment for syphilis, regardless of HIV status, there are inconsistencies in prescribing practices among clinicians.

RECENT FINDINGS

Two previous systematic reviews have found limited evidence for enhanced treatment of syphilis in the presence of HIV. However, a growing body of literature indicates that the rate of asymptomatic neurosyphilis may be higher in HIV, and that syphilis infection is associated with poorer long-term neurocognitive outcomes. A number of retrospective studies propose that serological response may be slower, or serological failure may be higher, among HIV-positive individuals, but these studies are limited by high loss to follow-up, high reinfection rates and a focus on serological rather than clinical response. Beyond penicillin, some evidence suggests equivalence of macrolides, cephalosporins and doxycycline, although macrolide resistance is an increasing concern.

SUMMARY

Until a prospective, randomized study is conducted, inconsistency with treatment will continue. We offer a pragmatic approach to recognizing patients who may require further investigation or neuropenetrative antibiotic treatment.

The rising trend of sexually transmitted infections among HIV-infected persons: a population-based cohort study in Taiwan, 2000 through 2010

OBJECTIVE

Positive prevention interventions for patients living with the HIV include the early detection and treatment of sexually transmitted infections (STIs). This study aimed to determine the incidence of selected STIs, including syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis, in a population-based cohort of individuals living with HIV.

METHODS

Clinical data from 2000 to 2010 were obtained from the Taiwan National Health Insurance Research Database identified 15,123 patients with HIV infection. The incidence rates were standardized by age and sex using the direct method that was based on the 2000 World Health Organization world standard population.

RESULTS

The overall rate ratio of STI episodes significantly increased [rate ratio: 34.0, 95% confidence interval (CI): 24.3 to 47.6, P < 0.01]. After an HIV diagnosis, 15.9% of patients with HIV had at least 1 of these 5 STIs. An incidence rate of 503.0 STI episodes/10,000 person-years (PYs) (95% CI: 487.1 to 519.5) was detected during the 11-year follow-up period. The most common STIs after an HIV diagnosis were syphilis (381.9 episodes/10,000 PYs; 95% CI: 368.0 to 396.3), followed by genital warts (138.9 episodes/10,000 PYs; 95% CI: 130.6 to 147.6). The incidence of STIs varied significantly according to gender. In women, the annual incidence of STIs remained stable. However, the annual incidence of syphilis, genital warts, and chlamydial infection increased in young men.

CONCLUSIONS

An increase in STIs among HIV-positive persons highlights the need to identify the causal factors of these co-infections. Routine STI screenings and early preventive interventions against STIs in HIV-infected persons are crucial.

History of syphilis in women living with AIDS and associated risk factors in São Paulo, Brazil

OBJECTIVE

to describe the epidemiological profile, risk behaviors, frequency of prior history of syphilis in women living with AIDS and to investigate associated factors.

METHODS

a cross-sectional study conducted with women living with HIV attending at Reference Center for AIDS in São Paulo. Demographic, behavioral, and clinical data were analyzed based on medical records.

RESULTS

a total of 598 women were included in the study and the prevalence of previous syphilis was 6.2% (95% CI 4,3-8,1). Seventy-three percent of women were less than 40 years of age when diagnosed with AIDS and 49.6% had more than eight years of formal education. 67.2% were white and 65.9% were not married or living with a partner, 53.2% reported that their first sexual intercourse aged more than 15 years, 56.5% reported having only one partner in the last year and 13% reported drug use. Regarding laboratory data, 83.8% had CD4+ <500 cells/ mm3 upon diagnosis of AIDS. Previous syphilis was associated with the use of crack cocaine [AOR = 6.8 (95% CI 1.7 - 27.5)], >1 sexual partner in the last year [AOR = 6.6 (95% CI 1.2 - 37.1)], CD4 + <500 cells/mm3 [AOR = 3.8 (women 1.1 - 13.6)], HIV diagnosis > 8 years [AOR = 2.4 (95% CI 1.0 - 5.8)].

CONCLUSION

a high prevalence of previous syphilis was found in the population studied, and crack use was identified among the main associated risk factors. Interventions to reduce the risk of sexual transmission of HIV and syphilis must be strengthened, with the implementation of control actions, screening strategies, early diagnosis and treatment, preventing complications, reducing morbidity and improving sexual and reproductive health.

Prevalence of antibodies against Treponema pallidum among HIV-positive patients in a tertiary care hospital in Mexico

Our objective was to determine the seroprevalence of syphilis among HIV-infected patients in a tertiary care hospital in Mexico City. A cross-sectional study was developed, and 318 HIV-positive patients were evaluated from January to February 2013 at Hospital de Infectología, National Medical Center 'La Raza' (a tertiary care hospital specialising in infectious diseases in Mexico City). Laboratory data were screened for the detection of antibodies against Treponema pallidum. Patients completed a questionnaire relating to socio-demographic data and factors associated with syphilis. Of the 318 patients, 83% were men. The mean age ± SD was 36 ± 11 years; 52% were men who have sex with men and 47% had undertaken higher education. The overall seroprevalence of syphilis among these patients was 25% (95% confidence interval 21%, 30%). Men who have sex with men had a significantly higher seroprevalence (30% vs. 15%, p = 0.009). We conclude that, in Mexico, there is a high seroprevalence of syphilis antibodies in HIV-infected patients and that men who have sex with men are the group most affected.

Poor Reporting of Outcomes Beyond Accuracy in Point-of-Care Tests for Syphilis: A Call for a Framework

Background. Point-of-care (POC) diagnostics for syphilis can contribute to epidemic control by offering a timely knowledge of serostatus. Although accuracy data on POC syphilis tests have been widely published, few studies have evaluated broader outcomes beyond accuracy that impact patients and health systems. We comprehensively reviewed evidence and reporting of these implementation research outcomes (IROs), and proposed a framework to improve their quality. Methods. Three reviewers systematically searched 6 electronic databases from 1980 to 2014 for syphilis POC studies reporting IROs. Data were abstracted and findings synthesised narratively. Results. Of 71 studies identified, 38 documented IROs. IROs were subclassified into preference (7), acceptability (15), feasibility (15), barriers and challenges (15), impact (13), and prevalence (23). Using our framework and definitions, a pattern of incomplete documentation, inconsistent definitions, and lack of clarity was identified across all IROs. Conclusion. Although POC screening tests for syphilis were generally favourably evaluated across a range of outcomes, the quality of evidence was compromised by inconsistent definitions, poor methodology, and documentation of outcomes. A framework for standardized reporting of outcomes beyond accuracy was proposed and considered a necessary first step towards an effective implementation of these metrics in POC diagnostics research.