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Dewart G, Muller J, Phillips JC, Banaszak D, Caine V. Interventions in maternal syphilis care globally: A scoping review. Health Care Women Int 2024; 45:1061-1080. [PMID: 38180353 DOI: 10.1080/07399332.2023.2294815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024]
Abstract
Infectious and Congenital Syphilis rates continue to rise globally. Current recommendations for syphilis screening and treatment may be insufficient, and there is a pressing need for improved programs and services to address the increase in cases. A scoping review was conducted to examine approaches to maternal syphilis screening and treatment. Theoretical underpinnings and the key characteristics of these interventions were studied to identify gaps in the existing literature to guide future research. Developing a modified version of the socio-ecological model to guide data analysis, we included 33 academic studies spanning 31 years, covering a range of interventions, programs, and policies globally. We highlight key facets of interventions aligning with the five levels of the modified model that include: individual, interpersonal, institutional, community and policy. In this review, we provide valuable insights into the characteristics and principles of maternal syphilis screening and treatment interventions.
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Affiliation(s)
- Georgia Dewart
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Jessica Muller
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - J Craig Phillips
- School of Nursing, Faculty of Health Sciences, Université d'Ottawa | University of Ottawa, Ottawa, Ontario, Canada
| | - Danielle Banaszak
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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2
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Ramchandani MS, Cannon CA, Marra CM. Syphilis. Infect Dis Clin North Am 2023; 37:195-222. [PMID: 37005164 DOI: 10.1016/j.idc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Syphilis is an important public health problem in the U.S. and many high-income nations. The rates of syphilis continue to increase and there is an urgent need for medical providers of a variety of backgrounds to recognize this disease. In this review, we cover the key clinical findings of syphilis and provide an overview of the diagnosis and management of this disease in adults.
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Bhargava A, Nagia S, Verma P, Bansal S, Khnuger N, Saxena A. Does performance and operational superiority of point-of-care test make it the investigation of choice in confirming syphilis? Indian J Sex Transm Dis AIDS 2022; 43:146-149. [PMID: 36743121 PMCID: PMC9891019 DOI: 10.4103/ijstd.ijstd_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background According to the World Health Organization, 6 million cases of syphilis occur every year. Serological tests for syphilis form the mainstay of diagnosis for syphilis. We evaluated the performance of point-of-care test (POCT) against other specific treponemal test for confirming the diagnosis of syphilis. Materials and Methods Does performance and operational superiority of POCT make it the investigation of choice in confirming syphilis? Retrospectively, data were analyzed of 599 serum samples from Apex Regional sexually transmitted disease centre, Safdarjung Hospital, New Delhi, received for testing by syphilis treponemal assays (both nontreponemal reactive and nonreactive). These samples underwent treponemal testing for syphilis by the Treponema pallidum hemagglutination (TPHA), fluorescent treponemal antibody absorption test (FTA-ABS), and POCT. Performance characteristics (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and diagnostic accuracy), and operational characteristics of POCT and TPHA were evaluated against the gold standard FTA-ABS. Results A total of 599 samples were evaluated, of which 61.76% were positive by FTA-ABS. On analysis, the sensitivity was 91.08% and 91.89%, specificity was 89.08% and 87.34%, PPV was 93.09% and 92.14%, NPV was 86.08% and 86.96%, and diagnostic accuracy was 90.32% and 90.15% for POCT and TPHA, respectively. The lower cost, shorter turnaround time, lesser infrastructure and workforce need, and easy availability make the POCT operationally superior to TPHA. Conclusion Owing to its operational superiority and higher specificity POCT can replace TPHA for confirming the diagnosis of Syphilis. POCT are affordable, equipment free, have room temperature storage, and yield result within 15 minutes, enabling same day testing and treatment. It can be used in a resource limited setting, for community setup or even self-testing.
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Affiliation(s)
- Aradhana Bhargava
- Apex Regional STD Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sonal Nagia
- Department of Dermatology and STD, Apex Regional STD Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Prashant Verma
- Department of Dermatology and STD, Apex Regional STD Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shikha Bansal
- Department of Dermatology and STD, Apex Regional STD Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Niti Khnuger
- Department of Dermatology and STD, Apex Regional STD Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashok Saxena
- Department of Dermatology and STD, Apex Regional STD Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Martin K, Wenlock R, Roper T, Butler C, Vera JH. Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review. BMC Infect Dis 2022; 22:561. [PMID: 35725437 PMCID: PMC9208134 DOI: 10.1186/s12879-022-07534-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so. Methods A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing. Results The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing. Conclusion Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07534-9.
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Affiliation(s)
- Kevin Martin
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK. .,Biomedical Research and Training Institute, Harare, Zimbabwe. .,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Rhys Wenlock
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Tom Roper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Ceri Butler
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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Brandenburger D, Ambrosino E. The impact of antenatal syphilis point of care testing on pregnancy outcomes: A systematic review. PLoS One 2021; 16:e0247649. [PMID: 33765040 PMCID: PMC7993761 DOI: 10.1371/journal.pone.0247649] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/10/2021] [Indexed: 12/26/2022] Open
Abstract
Background Mother-to-child transmission of syphilis remains a leading cause of neonatal death and stillbirth, disproportionally affecting women in low-resource settings where syphilis prevalence rates are high and testing rates low. Recently developed syphilis point-of-care tests (POCTs) are promising alternatives to conventional laboratory screening in low-resource settings as they do not require a laboratory setting, intensive technical training and yield results in 10–15 minutes thereby enabling both diagnosis and treatment in a single visit. Aim of this review was to provide clarity on the benefits of different POCTs and assess whether the implementation of syphilis POCTs is associated with decreased numbers of syphilis-related adverse pregnancy outcomes. Methods Following the PRISMA guidelines, three electronic databases (PubMed, Medline (Ovid), Cochrane) were systematically searched for intervention studies and cost-effectiveness analyses investigating the association between antenatal syphilis POCT and pregnancy outcomes such as congenital syphilis, low birth weight, prematurity, miscarriage, stillbirth as well as perinatal, fetal or infant death. Results Nine out of 278 initially identified articles were included, consisting of two clinical studies and seven modelling studies. Studies compared the effect on pregnancy outcomes of treponemal POCT, non-treponemal POCT and dual POCT to laboratory screening and no screening program. Based on the clinical studies, significantly higher testing and treatment rates, as well as a significant reduction (93%) in adverse pregnancy outcomes was reported for treponemal POCT compared to laboratory screening. Compared to no screening and laboratory screening, modelling studies assumed higher treatment rates for POCT and predicted the most prevented adverse pregnancy outcomes for treponemal POCT, followed by a dual treponemal and non-treponemal POCT strategy. Conclusion Implementation of treponemal POCT in low-resource settings increases syphilis testing and treatment rates and prevents the most syphilis-related adverse pregnancy outcomes compared to no screening, laboratory screening, non-treponemal POCT and dual POCT. Regarding the benefits of dual POCT, more research is needed. Overall, this review provides evidence on the contribution of treponemal POCT to healthier pregnancies and contributes greater clarity on the impact of diverse diagnostic methods available for the detection of syphilis.
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MESH Headings
- Abortion, Spontaneous/diagnosis
- Abortion, Spontaneous/economics
- Abortion, Spontaneous/prevention & control
- Cost-Benefit Analysis
- Developing Countries
- Female
- Humans
- Infant
- Infant Mortality/trends
- Infant, Low Birth Weight
- Infant, Newborn
- Infectious Disease Transmission, Vertical/prevention & control
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Point-of-Care Testing/economics
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/economics
- Pregnancy Complications, Infectious/prevention & control
- Prenatal Diagnosis/economics
- Prenatal Diagnosis/methods
- Stillbirth
- Syphilis/diagnosis
- Syphilis/economics
- Syphilis/prevention & control
- Syphilis Serodiagnosis/economics
- Syphilis Serodiagnosis/methods
- Treponema pallidum/immunology
- Treponema pallidum/pathogenicity
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Affiliation(s)
- Dana Brandenburger
- Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Elena Ambrosino
- Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Development), Institute for Public Health Genomics (IPHG), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
- * E-mail:
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Mashamba-Thompson TP, Drain PK, Kuupiel D, Sartorius B. Impact of Implementing Antenatal Syphilis Point-of-Care Testing on Maternal Mortality in KwaZulu-Natal, South Africa: An Interrupted Time Series Analysis. Diagnostics (Basel) 2019; 9:diagnostics9040218. [PMID: 31835603 PMCID: PMC6963181 DOI: 10.3390/diagnostics9040218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Syphilis infection has been associated with an increased risk of HIV infection during pregnancy which poses greater risk for maternal mortality, and antenatal syphilis point-of-care (POC) testing has been introduced to improve maternal and child health outcomes. There is limited evidence on the impact of syphilis POC testing on maternal outcomes in high HIV prevalent settings. We used syphilis POC testing as a model to evaluate the impact of POC diagnostics on the improvement of maternal mortality in KwaZulu-Natal, South Africa. Methods: We extracted 132 monthly data points on the number of maternal deaths in facilities and number of live births in facilities for 12 tertiary healthcare facilities in KwaZulu-Natal (KZN), South Africa from 2004 to 2014 from District Health Information System (DHIS) health facility archived. We employed segmented Poisson regression analysis of interrupted time series to assess the impact of the exposure on maternal mortality ratio (MMR) before and after the implementation of antenatal syphilis POC testing. We processed and analyzed data using Stata Statistical Software: Release 13. (Stata, Corp LP, College Station, TX, USA). Results: The provincial average annual maternal mortality ratio (MMR) was estimated at 176.09 ± 43.92 ranging from a minimum of 68.48 to maximum of 225.49 per 100,000 live births. The data comprised 36 temporal points before the introduction of syphilis POC test exposure and 84 after the introduction in primary health care clinics in KZN. The average annual MMR for KZN from 2004 to 2014 was estimated at 176.09 ± 43.92. A decrease in MMR level was observed during 2008 after syphilis POC test implementation, followed by a rise during 2009. Analysis of the MMR trend estimates a significant 1.5% increase in MMR trends during the period before implementation and 1.3% increase after implementation of syphilis POC testing (p < 0.001). Conclusion: Although our finding suggests a brief reduction in the MMR trend after the implementation of antenatal syphilis POC testing, a continued increase in syphilis rates is seen in KwaZulu-Natal, South Africa. The study used one of the most powerful quasi-experimental research methods, segmented Poisson regression analysis of interrupted time series to model the impact of syphilis POC on maternal outcome. The study finding requires confirmation by use of more rigorous primary study design.
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Affiliation(s)
- Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (T.P.M.-T.); (B.S.)
| | - Paul K. Drain
- International Clinical Research Center, Department of Global Health, University of Washington, Seattle, WA 98195-7965, USA;
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195-7965, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98195-7965, USA
- Department of Surgery, Harvard University, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (T.P.M.-T.); (B.S.)
- Correspondence:
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (T.P.M.-T.); (B.S.)
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Congenital Syphilis Prevention: Strategies, Evidence, and Future Directions. Sex Transm Dis 2019; 45:S29-S37. [PMID: 29624562 DOI: 10.1097/olq.0000000000000846] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Congenital syphilis (CS)-the preventable transmission of Treponema pallidum from infected mother to fetus-remains a significant problem worldwide. METHODS From July through November 2017, 239 articles relevant to CS prevention were identified via keyword searches in PubMed and Google Scholar, ancestry searches, and expert recommendation. Articles were then assessed for (1) measurement of a specified CS or adverse pregnancy outcomes (APOs) and (2) geographic setting in high/upper middle income countries according to United Nations criteria. In total, 119 articles met inclusion criteria. These were then vetted for 1 of 3 arms of CS prevention, after which additional ancestral searches were conducted within each arm to arrive at the final collection of articles per CS prevention strategy-maternal prenatal treatment (n = 33), prenatal screening (n = 24), and public health interventions that support screening and treatment (n = 15). RESULTS Of the 7 studies that evaluated treatment with benzathine penicillin G (BPG) use within the context of a modern health care system, all showed BPG to be highly effective in CS prevention; 3 additional studies demonstrated BPG effectiveness in preventing APOs. Ten studies revealed early disease detection through prenatal screening significantly reduces CS and APOs when paired with BPG. There was limited literature evaluating public health interventions, such as partner notification, surveillance, and prenatal screening laws. CONCLUSIONS Congenital syphilis is a preventable disease, effectively avoided with appropriate prenatal screening and BPG therapy. Increasing syphilis rates among all adults, accompanied by gaps in the provision of prenatal care to women at high risk of infection, are major contributors to CS persistence.
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Hachul M, Medeiros MVVD, Simões R, Bernardo WM. Sexually transmitted infections - laboratory diagnosis. ACTA ACUST UNITED AC 2019; 65:745-754. [PMID: 31340297 DOI: 10.1590/1806-9282.65.6.745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2019] [Indexed: 11/22/2022]
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Kularatne RS, Niit R, Rowley J, Kufa-Chakezha T, Peters RPH, Taylor MM, Johnson LF, Korenromp EL. Adult gonorrhea, chlamydia and syphilis prevalence, incidence, treatment and syndromic case reporting in South Africa: Estimates using the Spectrum-STI model, 1990-2017. PLoS One 2018; 13:e0205863. [PMID: 30321236 PMCID: PMC6188893 DOI: 10.1371/journal.pone.0205863] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To estimate trends in prevalence and incidence of syphilis, gonorrhea and chlamydia in adult men and women in South Africa. METHODS The Spectrum-STI tool estimated trends in prevalence and incidence of active syphilis, gonorrhea and chlamydia, fitting South African prevalence data. Results were used, alongside programmatic surveillance data, to estimate trends in incident gonorrhea cases resistant to first-line treatment, and the reporting gap of symptomatic male gonorrhea and chlamydia cases treated but not reported as cases of urethritis syndrome. RESULTS In 2017 adult (15-49 years) the estimated female and male prevalences for syphilis were 0.50% (95% CI: 0.32-0.80%) and 0.97% (0.19-2.28%), for gonorrhea 6.6% (3.8-10.8%) and 3.5% (1.7-6.1%), and for chlamydia 14.7% (9.9-21%) and 6.0% (3.8-10.4%), respectively. Between 1990 and 2017 the estimated prevalence of syphilis declined steadily in women and men, probably in part reflecting improved treatment coverage. For gonorrhea and chlamydia, estimated prevalence and incidence showed no consistent time trend in either women or men. Despite growing annual numbers of gonorrhea cases - reflecting population growth - the estimated number of first line treatment-resistant gonorrhea cases did not increase between 2008 and 2017, owing to changes in first-line antimicrobial treatment regimens for gonorrhea in 2008 and 2014/5. Case reporting completeness among treated male urethritis syndrome episodes was estimated at 10-28% in 2017. CONCLUSION South Africa continues to suffer a high STI burden. Improvements in access and quality of maternal, STI and HIV health care services likely contributed to the decline in syphilis prevalence. The lack of any decline in gonorrhea and chlamydia prevalence highlights the need to enhance STI services beyond clinic-based syndromic case management, to reinvigorate primary STI and HIV prevention and, especially for women, to screen for asymptomatic infections.
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Affiliation(s)
- Ranmini S. Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronelle Niit
- Health Information Systems Programme, Pretoria, South Africa
| | - Jane Rowley
- Independent consultant, London, United Kingdom
| | - Tendesayi Kufa-Chakezha
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Remco P. H. Peters
- Anova Health Institute, Johannesburg, South Africa
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Melanie M. Taylor
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
- USA Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, United States of America
| | - Leigh F. Johnson
- University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa
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10
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Kularatne R. Use of rapid point-of-care diagnostic tests for the elimination of congenital syphilis: what is the evidence? S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2018.1512550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Ranmini Kularatne
- Centre for HIV & STI, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Clinical Microbiology & Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
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Bazzo ML, da Motta LR, Rudolf-Oliveira RCM, Bigolin A, Golfetto L, Mesquita F, Benzaken AS, Gaspar PC, Pires AFNPC, Ferreira Júnior ODC, Franchini M. Evaluation of seven rapid tests for syphilis available in Brazil using defibrinated plasma panels. Sex Transm Infect 2018; 93:S46-S50. [PMID: 29223962 DOI: 10.1136/sextrans-2017-053177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/13/2017] [Accepted: 07/27/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In 2012, the WHO estimated that 6 million new cases of syphilis per year would occur worldwide, including 937 000 in Brazil. Early diagnosis and treatment of syphilis are essential to reduce morbidity and prevent transmission. The availability of rapid tests (RTs) for this diagnosis means that testing can be performed more quickly, as a point-of-care test, even in non-laboratory environments and requires only simple technical training to antibodies detection. The objective of this study was to evaluate the performance and operational aspects of seven commercially available RTs for syphilis in Brazil. METHODS Seven rapid treponemal tests were evaluated for sensitivity, specificity, accuracy and Kappa value, according to a panel composed of 493 members. The operational performance of the assay was also determined for these tests. RESULTS The seven RTs showed sensitivity ranging from 94.5% to 100% when compared with the reference tests and specificity of between 91.5% and 100%. All the RTs evaluated presented good operational performance, and only one failed to present the minimum specificity as defined by Brazil's Ministry of Health. CONCLUSION All the tests presented good operational performance, and the professionals who performed them considered them to be easy to use and interpret. This evaluation is important for making informed choices of tests to be used in the Brazilian Unified Health System.
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Affiliation(s)
- Maria Luiza Bazzo
- Department of Clinical Analysis, Health Sciences Center, Laboratory of Molecular Biology, Microbiology and Serology, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Leonardo Rapone da Motta
- Research Laboratory on HIV/AIDS, Center for Life Sciences and Health, University of Caxias do Sul, Rua Francisco Getúlio Vargas, Caxias do Sul, Brazil
| | - Renata Cristina Messores Rudolf-Oliveira
- Department of Clinical Analysis, Health Sciences Center, Laboratory of Molecular Biology, Microbiology and Serology, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Alisson Bigolin
- Department of Clinical Analysis, Health Sciences Center, Laboratory of Molecular Biology, Microbiology and Serology, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Lisléia Golfetto
- Department of Clinical Analysis, Health Sciences Center, Laboratory of Molecular Biology, Microbiology and Serology, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Fábio Mesquita
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Adele Schwartz Benzaken
- Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul, Brasília, Distrito Federal, Brazil
| | - Pamela Cristina Gaspar
- Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul, Brasília, Distrito Federal, Brazil
| | - Ana Flavia Nacif P Coelho Pires
- Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul, Brasília, Distrito Federal, Brazil.,Faculdade de Medicina, Faculdade de Ciências de Saúde, Programa de Pós Graduação em Saúde Coletiva, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, Distrito Federal, Brazil
| | - Orlando da Costa Ferreira Júnior
- Laboratory of Molecular Virology, Institute of Biology, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Miriam Franchini
- Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul, Brasília, Distrito Federal, Brazil
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Phang Romero Casas C, Martyn-St James M, Hamilton J, Marinho DS, Castro R, Harnan S. Rapid diagnostic test for antenatal syphilis screening in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2018; 8:e018132. [PMID: 29467132 PMCID: PMC5855314 DOI: 10.1136/bmjopen-2017-018132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To undertake a systematic review and meta-analysis to evaluate the test performance including sensitivity and specificity of rapid immunochromatographic syphilis (ICS) point-of-care (POC) tests at antenatal clinics compared with reference standard tests (non-treponemal (TP) and TP tests) for active syphilis in pregnant women. METHODS Five electronic databases were searched (PubMed, EMBASE, CRD, Cochrane Library and LILACS) to March 2016 for diagnostic accuracy studies of ICS test and standard reference tests for syphilis in pregnant women. Methodological quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). A bivariate meta-analysis was undertaken to generate pooled estimates of diagnostic parameters. Results were presented using a coupled forest plot of sensitivity and specificity and a scatter plot. RESULTS The methodological quality of the five included studies with regards to risk of bias and applicability concern judgements was either low or unclear. One study was judged as high risk of bias for patient selection due to exclusion of pregnant women with a previous history of syphilis, and one study was judged at high risk of bias for study flow and timing as not all patients were included in the analysis. Five studies contributed to the meta-analysis, providing a pooled sensitivity and specificity for ICS of 0.85 (95% CrI: 0.73 to 0.92) and 0.98 (95% CrI: 0.95 to 0.99), respectively. CONCLUSIONS This review and meta-analysis observed that rapid ICS POC tests have a high sensitivity and specificity when performed in pregnant women at antenatal clinics. However, the methodological quality of the existing evidence base should be taken into consideration when interpreting these results. PROSPERO REGISTRATION NUMBER CRD42016036335.
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Affiliation(s)
- Carmen Phang Romero Casas
- Centro de Desenvolvimento Tecnológico em Saúde (CDTS), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Diseases of Neglected Populations (INCT/IDPN), National Council for Scientific and Technological Development (CNPq), Brazil
| | | | - Jean Hamilton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel S Marinho
- Centro de Desenvolvimento Tecnológico em Saúde (CDTS), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Diseases of Neglected Populations (INCT/IDPN), National Council for Scientific and Technological Development (CNPq), Brazil
| | - Rodolfo Castro
- National Institute for Science and Technology on Innovation on Diseases of Neglected Populations (INCT/IDPN), National Council for Scientific and Technological Development (CNPq), Brazil
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Instituto de Saúde Coletiva, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Sue Harnan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Laboratory Evaluation of a Smartphone-Based Electronic Reader of Rapid Dual Point-of-Care Tests for Antibodies to Human Immunodeficiency Virus and Treponema pallidum Infections. Sex Transm Dis 2018; 44:412-416. [PMID: 28604483 DOI: 10.1097/olq.0000000000000628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Dual point-of-care tests for antibodies to human immunodeficiency virus (HIV) and Treponema pallidum allow for same-day testing and treatment and have been demonstrated to be cost-effective in preventing the adverse outcomes of HIV infection and syphilis. By recording and transmitting data as they are collected, electronic readers address challenges related to the decentralization of point-of-care testing. METHODS We evaluated a smartphone-based electronic reader using 201 sera tested with 2 dual rapid tests for detection of antibodies to HIV and T. pallidum in Los Angeles, USA, and Lima, Peru. Tests were read both visually and with the electronic reader. Enzyme immunoassay followed by Western blot and T. pallidum particle agglutination were the reference tests for HIV and T. pallidum, respectively. RESULTS The sensitivities of the 2 rapid tests for detection of HIV were 94.1% and 97.0% for electronic readings. Both tests had a specificity of 100% for detection of HIV by electronic reading. The sensitivities of the 2 rapid tests for detection of T. pallidum were 86.5% and 92.4% for electronic readings. The specificities for detection of T. pallidum were 99.1% and 99.0% by electronic reading. There were no significant differences between the accuracies of visual and electronic readings, and the performance did not differ between the 2 study sites. CONCLUSIONS Our results show the electronic reader to be a promising option for increasing the use of point-of-care testing programs.
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de Jongh TE, Gurol-Urganci I, Allen E, Zhu NJ, Atun R. Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review. J Glob Health 2018; 6:010403. [PMID: 27231539 PMCID: PMC4871065 DOI: 10.7189/jogh.06.010403] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Antenatal care (ANC) presents a potentially valuable platform for integrated delivery of additional health services for pregnant women–services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low– and middle–income countries (LMICs). However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs. Methods Cochrane Library, MEDLINE, Embase, CINAHL Plus, POPLINE and Global Health were searched for studies that compared integrated models for delivery of postnatal and other health services with ANC to non–integrated models. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle–Ottawa Scale, depending on the study design. Due to high heterogeneity no meta–analysis could be conducted. Results are presented narratively. Findings 12 studies were included in the review. Limited evidence, with moderate– to high–risk of bias, suggests that integrated service delivery results in improved uptake of essential health services for women, earlier initiation of treatment, and better health outcomes. Women also reported improved satisfaction with integrated services. Conclusions The reported evidence is largely based on non–randomised studies with poor generalizability, and therefore offers very limited policy guidance. More rigorously conducted and geographically diverse studies are needed to better ascertain and quantify the health and economic benefits of integrating health services with ANC.
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Affiliation(s)
| | | | - Elizabeth Allen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston MA, USA
| | - Nina Jiayue Zhu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston MA, USA
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Bauer WS, Gulka CP, Silva-Baucage L, Adams NM, Haselton FR, Wright DW. Metal Affinity-Enabled Capture and Release Antibody Reagents Generate a Multiplex Biomarker Enrichment System that Improves Detection Limits of Rapid Diagnostic Tests. Anal Chem 2017; 89:10216-10223. [DOI: 10.1021/acs.analchem.7b01513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Westley S. Bauer
- Department
of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Christopher P. Gulka
- Department
of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Lidalee Silva-Baucage
- Department
of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Nicholas M. Adams
- Department
of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Frederick R. Haselton
- Department
of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - David W. Wright
- Department
of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States
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Introducing onsite antenatal syphilis screening in Burkina Faso: implementation and evaluation of a feasibility intervention tailored to a local context. BMC Health Serv Res 2017; 17:378. [PMID: 28558812 PMCID: PMC5450306 DOI: 10.1186/s12913-017-2325-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the advantages of introducing point of care testing for syphilis in antenatal care (ANC) are well documented, there is little evidence on how to address structural issues within health systems. A better understanding of how these interventions work in a range of settings and contexts is needed in order to overcome bottlenecks at health system level. To better understand the relationships between implementation and context we developed and implemented an intervention focused on integrating a rapid screening test for syphilis in ANC services in rural primary health care facilities in Burkina Faso. This manuscript describes the intervention and reports on feasibility and acceptability of the intervention, the facilitators and barriers to the implementation of this intervention and the likelihood that point of care test for syphilis will become routinely incorporated in practice. METHODS In Kaya Health and Demographic Surveillance System (Kaya HDSS), all 7 primary healthcare facilities were selected for intervention in 2013. A participatory approach was used to design and implement an antenatal syphilis screening intervention. The Normalization Process Model (NPM) proposed by May et al. was adapted in order to identify barriers and facilitators and to explore the likelihood to become routinely incorporated in practice. Registers, Observations (n = 14 ANC 1) of interactions between patients and health workers during ANC and interviews with health workers (n = 14) were our data sources. RESULTS An intervention that included onsite training, provision of supplies and medicines, quality control and supervision was implemented in 7 health facilities in 2013. Rapid syphilis test and treatment were delivered during ANC within the examination room with no specific additional mechanism regarding staff organization. The perceived barriers were lack of training of all staff, workload, stock-outs of consumables and lack of motivation of staff. Key facilitators included political environment, ease of use of test and acceptability to pregnant women. CONCLUSIONS Onsite testing for antenatal syphilis is a feasible and acceptable intervention in ANC at primary health facility in Burkina Faso. The point-of care test for syphilis is more likely to be acceptable by health workers as routine service and incorporated as a normal practice. TRIAL REGISTRATION The study was retrospectively registered on ClinicalTrials.gov under the Trial Registration Number NCT03156751 .
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Rogozińska E, Kara-Newton L, Zamora JR, Khan KS. On-site test to detect syphilis in pregnancy: a systematic review of test accuracy studies. BJOG 2017; 124:734-741. [PMID: 28029229 DOI: 10.1111/1471-0528.14455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Syphilis in pregnancy can lead to fetal and neonatal death or congenital anomalies. Accurate on-site tests are an essential part of effective prevention of mother-to-child transmission of the disease. OBJECTIVE This systematic review assessed the accuracy of on-site tests to detect infection with Treponema pallidum in pregnant women. SEARCH STRATEGY Major databases were searched from inception to January 2016 using terms: 'pregnancy', 'antenatal', 'syphilis', 'Treponema pallidum' with their variations, and the search limit for the relevant study design. SELECTION CRITERIA We included studies that used dual reference standard (non-treponemal and treponemal tests) to detected syphilis in pregnancy. DATA COLLECTION AND ANALYSIS Extracted accuracy data were tabulated and pooled using hierarchical, bivariate random effects model. MAIN RESULTS Seven studies (combined sample 17 546) reporting the accuracy of four on-site tests met the eligibility criteria. On average, Determine™ and SD BioLine Syphilis 3.0 had the highest sensitivity of all the evaluated tests: 0.83 (95% CI 0.58, 0.98) and 0.86 (95% CI 0.82, 0.89), respectively, with a high specificity 0.96 (95% CI 0.89, 1.00) and 0.99 (95% CI 0.94, 1.00), respectively. The Qualitative Rapid Plasma Reagin card commonly used in clinical practice had a pooled sensitivity of 0.70 (95% CI 0.54, 0.88) and specificity of 0.97 (95% CI 0.96, 0.99). CONCLUSION Immunochromatographic tests such as Determine™ and SD BioLine Syphilis 3.0 seem to be acceptable options in antenatal testing for syphilis, especially in resource-limited settings. Future research should seek more evidence to strengthen this claim. TWEETABLE ABSTRACT On-site test to detect syphilis-options during antenatal care.
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Affiliation(s)
- E Rogozińska
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - L Kara-Newton
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - J R Zamora
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain
| | - K S Khan
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
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Marks M, Mabey DC. The introduction of syphilis point of care tests in resource limited settings. Expert Rev Mol Diagn 2017; 17:321-325. [PMID: 28266230 DOI: 10.1080/14737159.2017.1303379] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Syphilis remains an important and preventable cause of stillbirth and neonatal mortality. About 1 million women with active syphilis become pregnant each year. Without treatment, 25% of them will deliver a stillborn baby and 33% a low birth weight baby with an increased chance of dying in the first month of life. Adverse pregnancy outcomes due to syphilis can be prevented by screening pregnant women, and treating those who test positive with a single dose of penicillin before 28 weeks' gestation. Areas covered: This manuscript covers the impact of syphilis on pregnancy outcome, the diagnosis of syphilis, with a special focus on point of care (POC) tests, and challenges to the introduction of POC tests, and their potential impact on the control and prevention of syphilis in resource limited settings. Expert commentary: POC tests for syphilis are available which meet the ASSURED criteria, and could make syphilis screening accessible to all women anywhere in the world who attend an antenatal clinic. High quality dual POC tests for HIV and syphilis could ensure that well-funded programmes for the prevention of mother to child transmission of HIV can contribute towards increased coverage of antenatal syphilis screening, and prevent more than 300,000 adverse pregnancy outcomes due to syphilis annually. Alongside investment to increase availability of syphilis POC tests, operational research is needed to understand how best to improve screening of pregnant women and to translate test availability into improved pregnancy outcomes.
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Affiliation(s)
- Michael Marks
- a London School of Hygiene & Tropical Medicine , Keppel Street, London , WC1E 7HT
| | - David Cw Mabey
- a London School of Hygiene & Tropical Medicine , Keppel Street, London , WC1E 7HT
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Abstract
In industrialized countries, the incidence of syphilis has decreased dramatically since the discovery of penicillin in the 1940s. However, syphilis and congenital syphilis are far from eradicated, especially in low- and middle-income countries. Syphilis in pregnant women is a cause of adverse pregnancy outcomes that can be prevented by screening for syphilis and early treatment in pregnancy. Several studies have found screening of pregnant women for syphilis to be a highly cost-effective intervention, even if the prevalence of syphilis is low. Obstacles to universal screening of pregnant women include low awareness of syphilis and low quality of antenatal care and healthcare in general in many low- and middle-income countries. For these settings, we need simpler and more reliable serological tests for syphilis, but we also need to strengthen health services in general to ensure sustainable antenatal care services to ensure sustainability of syphilis screening programmes.
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Affiliation(s)
- Anne Buvé
- Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Begium, Tel.: + 32 3247 6533; Fax: + 32 3247 6532
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de Jongh TE, Gurol-Urganci I, Allen E, Jiayue Zhu N, Atun R. Barriers and enablers to integrating maternal and child health services to antenatal care in low and middle income countries. BJOG 2016; 123:549-57. [PMID: 26861695 PMCID: PMC4768640 DOI: 10.1111/1471-0528.13898] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
Abstract
Antenatal care (ANC) represents a delivery platform for a broad range of health services; however, these opportunities are insufficiently utilised. This review explores key barriers and enablers for successful integration of health s"ervices with ANC in different contexts. Data from peer‐reviewed and grey literature were organised using the SURE checklist. We identified 46 reports focusing on integration of HIV, tuberculosis, malaria, syphilis or nutrition services with ANC from Asia, Africa and the Pacific. Perspectives of service users and providers, social and political factors, and health system characteristics (such as resource availability and organisational structures) affected ease of integration. Tweetable abstract Health system factors, context and stakeholders must be considered for integrated antenatal care services. Health system factors, context and stakeholders must be considered for integrated antenatal care services.
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Affiliation(s)
| | | | - E Allen
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - N Jiayue Zhu
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - R Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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Kashyap B, Sagar T, Kaur IR. Utility of immunochromatographic assay as a rapid point of care test for screening of antenatal syphilis. Indian J Sex Transm Dis AIDS 2015; 36:162-5. [PMID: 26692609 DOI: 10.4103/0253-7184.167159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Syphilis is one of the most common preventable causes of adverse effects during pregnancy. Antenatal screening prevents the delay between diagnosis and treatment there by reducing the risk of congenital syphilis. The objective of this study was to evaluate the utility of an immunochromatographic assay as a point of care test for antenatal screening of syphilis. MATERIALS AND METHODS Sera of 200 antenatal mothers were evaluated for serodiagnosis of syphilis by the venereal disease research laboratory (VDRL), Treponema pallidum hemagglutination assay (TPHA) and SD BIOLINE Syphilis 3.0 test. The performance of SD BIOLINE Syphilis 3.0 test was compared with VDRL as screening assay and TPHA as a confirmatory test. RESULTS The antenatal prevalence of syphilis was found to be 2% by both VDRL and TPHA. The sensitivity, specificity, positive predictive value, and the negative predictive value of SD BIOLINE Syphilis 3.0 test were 75%, 100%, 100%, and 99.45%, respectively. CONCLUSIONS Antenatal screening and treatment of maternal syphilis are cost-effective health interventions even under the low prevalence of infection. SD BIOLINE Syphilis 3.0 test, although having less sensitivity than the existing testing strategy, can have a tremendous impact on the disease burden if used prudently for the screening of antenatal mothers in peripheral health settings.
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Affiliation(s)
- Bineeta Kashyap
- Deparment of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Tanu Sagar
- Deparment of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Iqbal R Kaur
- Deparment of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Mehra B, Bhalla P, Rawat D, Saxena S. An Audit of VDRL Testing from an STI Clinic in India: Analysing the Present Scenario with Focus on Estimating and Optimizing the Turnaround Time. J Clin Diagn Res 2015; 9:IC01-IC04. [PMID: 26435966 DOI: 10.7860/jcdr/2015/14179.6302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Timeliness of reporting is of utmost importance to limit the spread of syphilis. The present analysis was undertaken to evaluate the turnaround time of syphilis testing (mainly Venereal disease research laboratory /VDRL test) in a sexually transmitted infections (STI) clinic in India; to find out the possible reasons for delay; to describe the trends of clinical indications for syphilis testing from an STI clinic; to assess the frequency of a positive syphilis serology among STI clinic attendees; and to analyse the follow-up rates of VDRL report collection. MATERIALS AND METHODS Two hundred consecutive VDRL requests received at the serology laboratory of a tertiary care health facility from the STI clinic of the linked hospital were prospectively analysed to evaluate the above parameters. RESULTS For the 200 requests audited, the mean absolute turnaround time of VDRL test was 7.46±2.81 days. The mean duration of the pre-laboratory, laboratory and post laboratory phases was 0, 4.69±2.13 and 2.77±2.51 days respectively. The interval from specimen receipt to performance of tests (mean duration=4.25±1.96 days) was the major reason for long VDRL turnaround time. The common indications for syphilis testing in STI clinic attendees were lower abdominal pain (33%), vaginal discharge (26.5%) and genital ulcer disease (9%); and the follow-up rate for report collection was 71%. CONCLUSION Our study highlights the strong need to shift to alternative testing methods, mainly rapid point of care procedures for serodiagnosis of syphilis in order to circumvent the problems of long turnaround time and low patient follow-up rates.
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Affiliation(s)
- Bhanu Mehra
- Senior Resident, Department of Microbiology, Maulana Azad Medical College , New Delhi, India
| | - Preena Bhalla
- Director Professor, Department of Microbiology, Maulana Azad Medical College , New Delhi, India
| | - Deepti Rawat
- Assistant Professor, Department of Microbiology, Maulana Azad Medical College , New Delhi, India
| | - Shikhar Saxena
- Junior Resident, Department of Microbiology, Maulana Azad Medical College , New Delhi, India
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Terris-Prestholt F, Vickerman P, Torres-Rueda S, Santesso N, Sweeney S, Mallma P, Shelley KD, Garcia PJ, Bronzan R, Gill MM, Broutet N, Wi T, Watts C, Mabey D, Peeling RW, Newman L. The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia. Int J Gynaecol Obstet 2015; 130 Suppl 1:S73-80. [PMID: 25963907 PMCID: PMC4510253 DOI: 10.1016/j.ijgo.2015.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective Rapid plasma reagin (RPR) is frequently used to test women for maternal syphilis. Rapid syphilis immunochromatographic strip tests detecting only Treponema pallidum antibodies (single RSTs) or both treponemal and non-treponemal antibodies (dual RSTs) are now available. This study assessed the cost-effectiveness of algorithms using these tests to screen pregnant women. Methods Observed costs of maternal syphilis screening and treatment using clinic-based RPR and single RSTs in 20 clinics across Peru, Tanzania, and Zambia were used to model the cost-effectiveness of algorithms using combinations of RPR, single, and dual RSTs, and no and mass treatment. Sensitivity analyses determined drivers of key results. Results Although this analysis found screening using RPR to be relatively cheap, most (> 70%) true cases went untreated. Algorithms using single RSTs were the most cost-effective in all observed settings, followed by dual RSTs, which became the most cost-effective if dual RST costs were halved. Single test algorithms dominated most sequential testing algorithms, although sequential algorithms reduced overtreatment. Mass treatment was relatively cheap and effective in the absence of screening supplies, though treated many uninfected women. Conclusion This analysis highlights the advantages of introducing RSTs in three diverse settings. The results should be applicable to other similar settings.
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Affiliation(s)
| | - Peter Vickerman
- London School of Hygiene and Tropical Medicine, London, UK; University of Bristol, Bristol, UK
| | | | | | - Sedona Sweeney
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Rachel Bronzan
- Health and Development International, Newburyport, MA, USA
| | - Michelle M Gill
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | | | - Teodora Wi
- World Health Organization, Geneva, Switzerland
| | | | - David Mabey
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lori Newman
- World Health Organization, Geneva, Switzerland
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Ham DC, Lin C, Newman L, Wijesooriya NS, Kamb M. Improving global estimates of syphilis in pregnancy by diagnostic test type: A systematic review and meta-analysis. Int J Gynaecol Obstet 2015; 130 Suppl 1:S10-4. [PMID: 25963909 PMCID: PMC4591031 DOI: 10.1016/j.ijgo.2015.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND "Probable active syphilis," is defined as seroreactivity in both non-treponemal and treponemal tests. A correction factor of 65%, namely the proportion of pregnant women reactive in one syphilis test type that were likely reactive in the second, was applied to reported syphilis seropositivity data reported to WHO for global estimates of syphilis during pregnancy. OBJECTIVES To identify more accurate correction factors based on test type reported. SEARCH STRATEGY Medline search using: "Syphilis [Mesh] and Pregnancy [Mesh]," "Syphilis [Mesh] and Prenatal Diagnosis [Mesh]," and "Syphilis [Mesh] and Antenatal [Keyword]. SELECTION CRITERIA Eligible studies must have reported results for pregnant or puerperal women for both non-treponemal and treponemal serology. DATA COLLECTION AND ANALYSIS We manually calculated the crude percent estimates of subjects with both reactive treponemal and reactive non-treponemal tests among subjects with reactive treponemal and among subjects with reactive non-treponemal tests. We summarized the percent estimates using random effects models. MAIN RESULTS Countries reporting both reactive non-treponemal and reactive treponemal testing required no correction factor. Countries reporting non-treponemal testing or treponemal testing alone required a correction factor of 52.2% and 53.6%, respectively. Countries not reporting test type required a correction factor of 68.6%. CONCLUSIONS Future estimates should adjust reported maternal syphilis seropositivity by test type to ensure accuracy.
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Affiliation(s)
- D Cal Ham
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Carol Lin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lori Newman
- World Health Organization, Geneva, Switzerland
| | | | - Mary Kamb
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Canadian Public Health Laboratory Network laboratory guidelines for the use of point-of-care tests for the diagnosis of syphilis in Canada. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2015; 26 Suppl A:29A-32A. [PMID: 25798163 PMCID: PMC4353982 DOI: 10.1155/2015/152039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Syphilis point-of-care tests (POCT) are widely available in developing countries enabling early diagnosis, treatment and support. The majority of commercially available tests use treponemal antigens and the presence of antibodies does not distinguish between current and past infection, which may lead to unnecessary antibiotic use and stigmatization of having a current STI. In hard-to-reach populations, the benefits may outweigh the risks. Available studies show reasonable performance of POCT with median sensitivity of 86%, specificity of 99% and positive predictive values >80% when prevalence was >0.3%. Although no syphilis POCT are approved in Canada at this time, a single study in an outreach setting in Alberta showed limited benefit due to a high prevalence of previous infection but more studies are needed. Newer dual tests employing treponemal and nontreponemal antigens look promising.
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Manabe YC, Namale G, Nalintya E, Sempa J, Ratanshi RP, Pakker N, Katabira E. Integration of antenatal syphilis screening in an urban HIV clinic: a feasibility study. BMC Infect Dis 2015; 15:15. [PMID: 25583097 PMCID: PMC4302122 DOI: 10.1186/s12879-014-0739-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syphilis infection during pregnancy leads to avoidable morbidity and mortality and remains a significant problem in sub-Saharan Africa. Despite global initiatives to increase the proportion of pregnant women screened, implementation has been slow. We sought to investigate the feasibility of adding syphilis screening within an integrated antenatal HIV clinic. METHODS Pregnant women attending the HIV antenatal clinic were sequentially enrolled and consenting participants answered a questionnaire on sexual behavior and previous pregnancies, provided sociodemographic data, and were tested using rapid plasmin reagin (RPR). If positive, participants were treated with benzathine penicillin. All were given a partner notification slip and were followed up after delivery to determine birth outcomes. RESULTS 584 of 606 (95.7%) women approached and consented to test for syphilis. 570 women were enrolled (median age 29 (IQR 25-32) with a median (IQR) CD4 of 372 (257-569) cells/μL). Of the 5.1% (29/570) with a positive RPR, all were asymptomatic, were successfully contacted, and treated with benzathine penicillin without adverse reactions. Overall, 61 (12.1%) of the participants had an adverse birth outcome. In the bivariate analysis, only age was significantly different between those with and without a positive RPR (RR = 1.15, 95% CI 1.065-1.248; p < 0.001). Partners of only 10 (34.5%) participants returned for treatment. CONCLUSIONS Structural interventions such as opt-out testing for syphilis within integrated HIV-antenatal care clinics are feasible and capitalize on the excellent care programs that have already been established for HIV care. Novel approaches are required for partner notification.
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Affiliation(s)
- Yukari C Manabe
- Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda. .,Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Gertrude Namale
- Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda.
| | - Elizabeth Nalintya
- Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda.
| | - Joseph Sempa
- Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda.
| | - Rosalind Parkes Ratanshi
- Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda.
| | - Nadine Pakker
- Amsterdam Institute for Global Health and Development, Amsterdam Medical Center, Amsterdam, Netherlands.
| | - Elly Katabira
- Infectious Diseases Institute, Makerere College of Health Sciences, PO Box 22418, Mulago Hospital Complex, Kampala, Uganda. .,Department of Medicine, Makerere College of Health Sciences, Kampala, Uganda.
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Cost-effectiveness of integrated routine offering of prenatal HIV and syphilis screening in China. Sex Transm Dis 2014; 41:103-10. [PMID: 24413489 DOI: 10.1097/olq.0000000000000085] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In China, recent rises in syphilis and HIV cases have increased the focus on preventing mother-to-child transmission of these infections. We assess the health and economic outcomes of different strategies of prenatal HIV and syphilis screening from the local health department's perspective. METHODS A Markov cohort decision analysis model was used to estimate the health and economic outcomes of pregnancy using disease prevalence and cost data from local sources and, if unavailable, from published literature. Adverse pregnancy outcomes included induced abortion, stillbirth, low birth weight, neonatal death, congenital syphilis in live-born infants, and perinatal HIV infection. We examined 4 screening strategies: no screening, screening for HIV only, for syphilis only, and for both HIV and syphilis. We estimated disability-adjusted life years (DALYs) for each health outcome using life expectancies and infections for mothers and newborns. RESULTS For a simulated cohort of 10,000 pregnant women (0.07% prevalence for HIV and 0.25% for syphilis; 10% of HIV-positives were coinfected with syphilis), the estimated costs per DALY prevented were as follows: syphilis-only, $168; HIV-and-syphilis, $359; and HIV-only, $5636. The estimated incremental cost-effectiveness ratio if an existing HIV-only strategy added syphilis screening (i.e., move from the HIV-only strategy to the HIV-and-syphilis strategy) was $140 per additional DALY prevented. CONCLUSIONS Given the increasing prevalence of syphilis and HIV among pregnant women in China, prenatal HIV screening programs that also include syphilis screening are likely to be substantially more cost-effective than HIV screening alone and prevent many more adverse pregnancy outcomes.
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Liu F, Liu LL, Guo XJ, Xi Y, Lin LR, Zhang HL, Huang SJ, Chen YY, Zhang YF, Zhang Q, Huang GL, Tong ML, Jiang J, Yang TC. Characterization of the classical biological false-positive reaction in the serological test for syphilis in the modern era. Int Immunopharmacol 2014; 20:331-6. [DOI: 10.1016/j.intimp.2014.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/09/2014] [Accepted: 03/17/2014] [Indexed: 01/15/2023]
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Poor Reporting of Outcomes Beyond Accuracy in Point-of-Care Tests for Syphilis: A Call for a Framework. AIDS Res Treat 2014; 2014:465932. [PMID: 24795821 PMCID: PMC3985157 DOI: 10.1155/2014/465932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 02/23/2014] [Accepted: 02/27/2014] [Indexed: 11/24/2022] Open
Abstract
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.
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Causer LM, Kaldor JM, Fairley CK, Donovan B, Karapanagiotidis T, Leslie DE, Robertson PW, McNulty AM, Anderson D, Wand H, Conway DP, Denham I, Ryan C, Guy RJ. A laboratory-based evaluation of four rapid point-of-care tests for syphilis. PLoS One 2014; 9:e91504. [PMID: 24618681 PMCID: PMC3950184 DOI: 10.1371/journal.pone.0091504] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/11/2014] [Indexed: 11/24/2022] Open
Abstract
Background Syphilis point-of-care tests may reduce morbidity and ongoing transmission by increasing the proportion of people rapidly treated. Syphilis stage and co-infection with HIV may influence test performance. We evaluated four commercially available syphilis point-of-care devices in a head-to-head comparison using sera from laboratories in Australia. Methods Point-of-care tests were evaluated using sera stored at Sydney and Melbourne laboratories. Sensitivity and specificity were calculated by standard methods, comparing point-of-care results to treponemal immunoassay (IA) reference test results. Additional analyses by clinical syphilis stage, HIV status, and non-treponemal antibody titre were performed. Non-overlapping 95% confidence intervals (CI) were considered statistically significant differences in estimates. Results In total 1203 specimens were tested (736 IA-reactive, 467 IA-nonreactive). Point-of-care test sensitivities were: Determine 97.3%(95%CI:95.8–98.3), Onsite 92.5%(90.3–94.3), DPP 89.8%(87.3–91.9) and Bioline 87.8%(85.1–90.0). Specificities were: Determine 96.4%(94.1–97.8), Onsite 92.5%(90.3–94.3), DPP 98.3%(96.5–99.2), and Bioline 98.5%(96.8–99.3). Sensitivity of the Determine test was 100% for primary and 100% for secondary syphilis. The three other tests had reduced sensitivity among primary (80.4–90.2%) compared to secondary syphilis (94.3–98.6%). No significant differences in sensitivity were observed by HIV status. Test sensitivities were significantly higher among high-RPR titre (RPR≥8) (range: 94.6–99.5%) than RPR non-reactive infections (range: 76.3–92.9%). Conclusions The Determine test had the highest sensitivity overall. All tests were most sensitive among high-RPR titre infections. Point-of-care tests have a role in syphilis control programs however in developed countries with established laboratory infrastructures, the lower sensitivities of some tests observed in primary syphilis suggest these would need to be supplemented with additional tests among populations where syphilis incidence is high to avoid missing early syphilis cases.
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Affiliation(s)
- Louise M. Causer
- Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
| | - John M. Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - David E. Leslie
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
| | - Peter W. Robertson
- SEALS Area Serology Laboratory, Prince of Wales Hospital, Randwick, Australia
| | | | | | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Damian P. Conway
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Carlton, Australia
| | | | - Rebecca J. Guy
- Kirby Institute, University of New South Wales, Sydney, Australia
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Dlamini NR, Phili R, Connolly C. Evaluation of rapid syphilis tests in KwaZulu-Natal. J Clin Lab Anal 2014; 28:77-81. [PMID: 24395488 DOI: 10.1002/jcla.21647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/03/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite the considerable decrease in the seroprevalence of syphilis in South Africa, with an estimated prevalence of 1.5% in 2010, the disease remains a threat particularly to pregnant women, hence there is a need for a rapid, reliable, and affordable screening and diagnostic test. A laboratory evaluation study was conducted in response to a call by the KwaZulu-Natal (KZN) Provincial Department of Health that is considering using rapid point-of-care syphilis tests. METHODS The performances of the Hexagon and the SD Bioline syphilis tests were compared with the Treponema pallidum hemagglutination assay (TPHA) reference test using 297 (142 positive and 155 negative) serum specimens. RESULTS Both assays demonstrated good performance with negative and positive concordance of 97 and 94% for the Hexagon assay and 98 and 90% for SD Bioline assay, respectively, when compared to the TPHA. The Hexagon test was quicker and easier to read than the SD Bioline test. CONCLUSION Although the rapid syphilis tests performed favorably, a number of issues need to be considered prior to their use for syphilis screening in the public sector of South Africa.
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Affiliation(s)
- Nomonde Ritta Dlamini
- Department of Medical Microbiology, National Health Laboratory Service, Durban, South Africa
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Women and Children First: The Impact of Sexually Transmitted Infections on Maternal and Child Health. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2014; 2014:671085. [PMID: 26316975 PMCID: PMC4437399 DOI: 10.1155/2014/671085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 01/05/2014] [Indexed: 11/18/2022]
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Kay NS, Peeling RW, Mabey DC. State of the art syphilis diagnostics: rapid point-of-care tests. Expert Rev Anti Infect Ther 2013; 12:63-73. [PMID: 24308715 DOI: 10.1586/14787210.2014.860356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Syphilis remains an important and entirely preventable cause of stillbirth and neonatal mortality. More than 1 million women with active syphilis become pregnant each year. Without treatment, 25% of them will deliver a stillborn baby, 33% will deliver a live low-birth weight baby with an increased chance of dying in the first month of life. Adverse pregnancy outcomes due to syphilis can be prevented by screening pregnant women, and treating those who test positive with a single dose of penicillin before 28 weeks gestation. Until recently access to screening in low- and middle-income countries has been limited, since screening tests have been laboratory based, requiring equipment, electricity and trained laboratory staff. Now a number of rapid, cheap, simple and accurate screening tests are available and can give a result in 15-20 min, enabling those who require treatment to be treated at their first visit.
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Affiliation(s)
- Natasha S Kay
- St Mary's Hospital, Praed Street, W2 1NY, London, UK
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Smit PW, Mabey D, Changalucha J, Mngara J, Clark B, Andreasen A, Todd J, Urassa M, Zaba B, Peeling RW. The trade-off between accuracy and accessibility of syphilis screening assays. PLoS One 2013; 8:e75327. [PMID: 24066175 PMCID: PMC3774815 DOI: 10.1371/journal.pone.0075327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/12/2013] [Indexed: 11/24/2022] Open
Abstract
The availability of rapid and sensitive methods to diagnose syphilis facilitates screening of pregnant women, which is one of the most cost-effective health interventions available. We have evaluated two screening methods in Tanzania: an enzyme immunoassay (EIA), and a point-of-care test (POCT). We evaluated the performance of each test against the Treponema pallidum particle agglutination assay (TPPA) as the reference method, and the accessibility of testing in a rural district of Tanzania. The POCT was performed in the clinic on whole blood, while the other assays were performed on plasma in the laboratory. Samples were also tested by the rapid plasma Reagin (RPR) test. With TPPA as reference assay, the sensitivity and specificity of EIA were 95.3% and 97.8%, and of the POCT were 59.6% and 99.4% respectively. The sensitivity of the POCT and EIA for active syphilis cases (TPPA positive and RPR titer ≥ 1/8) were 82% and 100% respectively. Only 15% of antenatal clinic attenders in this district visited a health facility with a laboratory capable of performing the EIA. Although it is less sensitive than EIA, its greater accessibility, and the fact that treatment can be given on the same day, means that the use of POCT would result in a higher proportion of women with syphilis receiving treatment than with the EIA in this district of Tanzania.
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Affiliation(s)
- Pieter W. Smit
- Department of Infectious & Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Mabey
- Department of Infectious & Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Julius Mngara
- National Institute for Medical Research, Mwanza, Tanzania
| | - Benjamin Clark
- National Institute for Medical Research, Mwanza, Tanzania
| | - Aura Andreasen
- Department of Infectious & Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Mwanza intervention Trials Unit, Mwanza, Tanzania
| | - Jim Todd
- Department of Infectious & Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- National Institute for Medical Research, Mwanza, Tanzania
| | - Mark Urassa
- National Institute for Medical Research, Mwanza, Tanzania
| | - Basia Zaba
- Department of Infectious & Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rosanna W. Peeling
- Department of Infectious & Tropical diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Syphilis screening among 27,150 pregnant women in South Chinese rural areas using point-of-care tests. PLoS One 2013; 8:e72149. [PMID: 24009673 PMCID: PMC3756989 DOI: 10.1371/journal.pone.0072149] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/05/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives To determine the prevalence and correlates of syphilis among pregnant women in rural areas of South China. Methods Point-of-care syphilis testing was provided at 71 health facilities in less developed, rural areas of Guangdong Province. Positive samples were confirmed at a local referral center by toluidine red unheated serum tests (TRUST) and Treponema pallidum particle agglutination (TPPA) tests. Results Altogether 27,150 pregnant women in rural Guangdong were screened for syphilis. 106 (0.39%) syphilis cases were diagnosed, of which 78 (73.6%) received treatment for syphilis. Multivariate analysis revealed that older pregnant women (31–35 years old, aOR 2.7, 95% CI 0.99–7.32; older than 35 years old, aOR 5.9, 95% CI 2.13–16.34) and those with a history of adverse pregnant outcomes (aOR 3.64, 95% CI 2.30–5.76) were more likely to be infected with syphilis. Conclusions A high prevalence of syphilis exists among pregnant women living in rural areas of South China. Enhanced integration of syphilis screening with other routine women's health services (OB GYN, family planning) may be useful for controlling China's syphilis epidemic.
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García PJ, Cárcamo CP, Chiappe M, Valderrama M, La Rosa S, Holmes KK, Mabey DCW, Peeling RW. Rapid Syphilis Tests as Catalysts for Health Systems Strengthening: A Case Study from Peru. PLoS One 2013; 8:e66905. [PMID: 23840552 PMCID: PMC3694115 DOI: 10.1371/journal.pone.0066905] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 05/12/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives Untreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT) offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening. Methods The study was implemented from September 2009–November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability. Results Before the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the “two for one strategy”, offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%. Conclusions Implementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1) engaging the authorities; (2) dissipating tensions between providers and identifying champions; (3) training according to the needs; (4) providing monitoring, supervision, support and recognition; (5) sharing results and discussing actions together; (6) consulting and obtaining feedback from users; and (7) integrating with other services such as with rapid HIV testing.
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Affiliation(s)
- Patricia J. García
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - César P. Cárcamo
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marina Chiappe
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Valderrama
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sayda La Rosa
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration Universidad Peruana Cayetano Heredia, Lima, Peru
| | - King K. Holmes
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - David C. W. Mabey
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Jafari Y, Peeling RW, Shivkumar S, Claessens C, Joseph L, Pai NP. Are Treponema pallidum specific rapid and point-of-care tests for syphilis accurate enough for screening in resource limited settings? Evidence from a meta-analysis. PLoS One 2013; 8:e54695. [PMID: 23468842 PMCID: PMC3582640 DOI: 10.1371/journal.pone.0054695] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 12/17/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Rapid and point-of-care (POC) tests for syphilis are an invaluable screening tool, yet inadequate evaluation of their diagnostic accuracy against best reference standards limits their widespread global uptake. To fill this gap, a systematic review and meta-analysis was conducted to evaluate the sensitivity and specificity of rapid and POC tests in blood and serum samples against Treponema pallidum (TP) specific reference standards. METHODS Five electronic databases (1980-2012) were searched, data was extracted from 33 articles, and Bayesian hierarchical models were fit. RESULTS In serum samples, against a TP specific reference standard point estimates with 95% credible intervals (CrI) for the sensitivities of popular tests were: i) Determine, 90.04% (80.45, 95.21), ii) SD Bioline, 87.06% (75.67, 94.50), iii) VisiTect, 85.13% (72.83, 92.57), and iv) Syphicheck, 74.48% (56.85, 88.44), while specificities were: i) Syphicheck, 99.14% (96.37, 100), ii) Visitect, 96.45% (91.92, 99.29), iii) SD Bioline, 95.85% (89.89, 99.53), and iv) Determine, 94.15% (89.26, 97.66). In whole blood samples, sensitivities were: i) Determine, 86.32% (77.26, 91.70), ii) SD Bioline, 84.50% (78.81, 92.61), iii) Syphicheck, 74.47% (63.94, 82.13), and iv) VisiTect, 74.26% (53.62, 83.68), while specificities were: i) Syphicheck, 99.58% (98.91, 99.96), ii) VisiTect, 99.43% (98.22, 99.98), iii) SD Bioline, 97.95%(92.54, 99.33), and iv) Determine, 95.85% (92.42, 97.74). CONCLUSIONS Rapid and POC treponemal tests reported sensitivity and specificity estimates comparable to laboratory-based treponemal tests. In resource limited settings, where access to screening is limited and where risk of patients lost to follow up is high, the introduction of these tests has already been shown to improve access to screening and treatment to prevent stillbirths and neonatal mortality due to congenital syphilis. Based on the evidence, it is concluded that rapid and POC tests are useful in resource limited settings with poor access to laboratories or screening for syphilis.
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Affiliation(s)
- Yalda Jafari
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | | | - Sushmita Shivkumar
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | | | - Lawrence Joseph
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University and MUHC, Montréal, Canada
| | - Nitika Pant Pai
- Division of Clinical Epidemiology, Department of Medicine, McGill University and MUHC, Montréal, Canada
- * E-mail:
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Galvao TF, Silva MT, Serruya SJ, Newman LM, Klausner JD, Pereira MG, Fescina R. Safety of benzathine penicillin for preventing congenital syphilis: a systematic review. PLoS One 2013; 8:e56463. [PMID: 23437138 PMCID: PMC3578834 DOI: 10.1371/journal.pone.0056463] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/09/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To estimate the risk of serious adverse reactions to benzathine penicillin in pregnant women for preventing congenital syphilis. METHODS We searched for clinical trials or cohorts that assessed the incidence of serious adverse reactions to benzathine penicillin in pregnant women and the general population (indirect evidence). MEDLINE, EMBASE, Scopus and other databases were searched up to December 2012. The GRADE approach was used to assess quality of evidence. Absolute risks of each study were calculated along with their 95% confidence intervals (95% CI). We employed the DerSimonian and Laird random effects model in the meta-analyses. RESULTS From 2,765 retrieved studies we included 13, representing 3,466,780 patients. The studies that included pregnant women were conducted to demonstrate the effectiveness of benzathine penicillin: no serious adverse reactions were reported among the 1,244 pregnant women included. In the general population, among 2,028,982 patients treated, 4 died from an adverse reaction. The pooled risk of death was virtually zero. Fifty-four cases of anaphylaxis were reported (pooled absolute risk = 0.002%; 95% CI: 0%-0.003% I(2) = 12%). From that estimate, penicillin treatment would be expected to result in an incidence of 0 to 3 cases of anaphylaxis per 100,000 treated. Any adverse reactions were reported in 6,377 patients among 3,465,322 treated with penicillin (pooled absolute risk = 0.169%; 95% CI: 0.073%-0.265% I(2) = 97%). The quality of evidence was very low. CONCLUSION Studies that assessed the risk of serious adverse events due to benzathine penicillin treatment in pregnant women were scarce, but no reports of adverse reactions were found. The incidence of severe adverse outcomes was very low in the general population. The risk of treating pregnant women with benzathine penicillin to prevent congenital syphilis appears very low and does not outweigh its benefits. Further research is needed to improve the quality of evidence.
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Affiliation(s)
- Tais F Galvao
- University of Brasilia, Faculty of Medicine, Brasilia, Distrito Federal, Brazil.
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Tan NX, Rydzak C, Yang LG, Vickerman P, Yang B, Peeling RW, Hawkes S, Chen XS, Tucker JD. Prioritizing congenital syphilis control in south China: a decision analytic model to inform policy implementation. PLoS Med 2013; 10:e1001375. [PMID: 23349624 PMCID: PMC3551934 DOI: 10.1371/journal.pmed.1001375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 12/14/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Syphilis is a major public health problem in many regions of China, with increases in congenital syphilis (CS) cases causing concern. The Chinese Ministry of Health recently announced a comprehensive 10-y national syphilis control plan focusing on averting CS. The decision analytic model presented here quantifies the impact of the planned strategies to determine whether they are likely to meet the goals laid out in the control plan. METHODS AND FINDINGS Our model incorporated data on age-stratified fertility, female adult syphilis cases, and empirical syphilis transmission rates to estimate the number of CS cases associated with prenatal syphilis infection on a yearly basis. Guangdong Province was the focus of this analysis because of the availability of high-quality demographic and public health data. Each model outcome was simulated 1,000 times to incorporate uncertainty in model inputs. The model was validated using data from a CS intervention program among 477,656 women in China. Sensitivity analyses were performed to identify which variables are likely to be most influential in achieving Chinese and international policy goals. Increasing prenatal screening coverage was the single most effective strategy for reducing CS cases. An incremental increase in prenatal screening from the base case of 57% coverage to 95% coverage was associated with 106 (95% CI: 101, 111) CS cases averted per 100,000 live births (58% decrease). The policy strategies laid out in the national plan led to an outcome that fell short of the target, while a four-pronged comprehensive syphilis control strategy consisting of increased prenatal screening coverage, increased treatment completion, earlier prenatal screening, and improved syphilis test characteristics was associated with 157 (95% CI: 154, 160) CS cases averted per 100,000 live births (85% decrease). CONCLUSIONS The Chinese national plan provides a strong foundation for syphilis control, but more comprehensive measures that include earlier and more extensive screening are necessary for reaching policy goals.
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Affiliation(s)
- Nicholas X Tan
- Harvard Institute for Global Health, Cambridge, Massachusetts, USA
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Yáñez-Alvarez I, Conde-González CJ, Uribe-Salas FJ, Olamendi-Portugal ML, García-Cisneros S, Sánchez-Alemán MA. Maternal/Child Seroprevalence of Antibodies Against Treponema pallidum at Four General Hospitals in the State of Morelos, Mexico. Arch Med Res 2012; 43:571-7. [DOI: 10.1016/j.arcmed.2012.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 09/14/2012] [Indexed: 11/27/2022]
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Cost-effectiveness of a dual non-treponemal/treponemal syphilis point-of-care test to prevent adverse pregnancy outcomes in sub-Saharan Africa. Sex Transm Dis 2012; 38:997-1003. [PMID: 21992974 DOI: 10.1097/olq.0b013e3182260987] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A dual nontreponemal/treponemal point-of-care test (Dual-POC) that simultaneously detects both nontreponemal and treponemal antibodies has been developed and evaluated. In this study, we compare the health and economic outcomes of the new test with existing syphilis tests/testing algorithms in a high prevalence setting. METHODS We used a cohort decision analysis model to examine 4 testing/screening algorithms; the Dual-POC test, the laboratory-based rapid plasma reagin and Treponema pallidum haemagglutination assay (RPR+TPHA) algorithm, an onsite RPR testing, and point-of-care treponemal immunochromatographic strip (ICS) testing. Outcomes included miscarriage, stillbirth, congenital syphilis, low birth weight, and neonatal death. Disability-adjusted life-years were estimated for all health outcomes. The analytic horizon was the life expectancy for the mother and child. RESULTS For a cohort of 1000 pregnant women in a historically high syphilis prevalence population (10% infected and 15% previously infected), the model predicted a total of 39 adverse pregnancy outcomes if no serologic screening were performed; 13 for the laboratory-based RPR+TPHA; 11 for the on-site RPR strategy; 5 for the Dual-POC strategy; and 2 for the ICS strategy. On the basis of assumption that the cost of ICS and the Dual-POC tests were the same, the ICS strategy was the most cost saving (saved $30,000) followed by the Dual-POC strategy (saved $27,000). CONCLUSIONS The dual-POC test may help save cost in resource-poor settings where disease prevalence (and loss to follow-up) is high, while substantially reducing overtreatment.
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The tale of two serologic tests to screen for syphilis--treponemal and nontreponemal: does the order matter? Sex Transm Dis 2012; 38:448-56. [PMID: 21183862 DOI: 10.1097/olq.0b013e3182036a0f] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Standard syphilis screening involves an initial screening with a nontreponemal test and confirmation of positives with a treponemal test. However, some laboratories have reversed the order. There is no detailed quantitative and qualitative evaluation for the order of testing. In this study, we analyzed the health and economic outcomes of the order of testing for the 2 serologic tests used in syphilis screening under pure screening settings. METHODS We used a cohort decision analysis to examine the health and economic outcomes of the screening algorithms for low and high prevalence settings. The 2-step algorithms were nontreponemal followed by treponemal (Nontrep-First) and treponemal followed by nontreponemal (Trep-First). We included the 1-step algorithms (treponemal only [Trep-Only] and an on-site nontreponemal only [Nontrep-Only]) for comparison. We estimated overtreatment rates and the number of confirmatory tests required for each algorithm. RESULTS For a cohort of 10,000 individuals, our results indicated that the overtreatment rates were substantially higher (more than 3 times) for the 1-step algorithms, although they treated a higher number of cases (over 15%). The 2-step algorithms detected and treated the same number of individuals. Among the 2-step algorithms, the Nontrep-First was more cost-effective in the low prevalence setting ($1400 vs. $1500 per adverse outcome prevented) and more cost-saving ($102,000 vs. $84,000) in the high prevalence setting. CONCLUSIONS The difference in cost was largely due to the substantially higher number of confirmatory tests required for the Trep-First algorithm, although the number of cases detected and treated was the same.
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Yang LG, Tucker JD, Wang C, Shen SY, Chen XS, Yang B, Peeling R. Syphilis test availability and uptake at medical facilities in southern China. Bull World Health Organ 2011; 89:798-805. [PMID: 22084525 DOI: 10.2471/blt.11.089813] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 07/16/2011] [Accepted: 07/19/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine syphilis testing capacity, screening coverage rates and types of syphilis tests used in medical facilities in southern China. METHODS Eleven of the 14 municipalities in Guangdong province participated. Data on syphilis testing capacity, screening coverage and types of syphilis tests used were collected from all types of public medical facilities offering prenatal care (n = 109). A total of 494 680 women who delivered during 2004-2008 were studied. FINDINGS In 2008, 54 196 pregnant women (43.1%) were not screened for syphilis. Among such women, 32 863 (60.6%) attended clinics without any syphilis testing capacity and 21 333 (39.4%) attended clinics that performed testing but were not screened. The likelihood of not having syphilis test capacity was much higher for hygiene stations (odds ratio, OR: 10; 95% confidence interval, CI: 4-25), services at the township level (OR: 33; 95% CI: 10-100) and services with ≤ 1000 deliveries per year (OR: 1.002; 95% CI: 1.001-1.003). These same service characteristics correlated with lower screening coverage rates (P < 0.01). Only one antenatal clinic had the capacity to conduct both treponemal and non-treponemal tests for diagnosing syphilis. CONCLUSION Syphilis screening is available in very few of the basic medical facilities offering prenatal care where most neonates in southern China are delivered. In light of this and of the increasing incidence of syphilis in the area, expanding point-of-care rapid syphilis testing is a priority.
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Affiliation(s)
- Li-Gang Yang
- Guangdong Provincial Center for STI Control & Prevention, Division of STD Control, No.10 Xian Lie Dong Heng Rd, Guangzhou 510500, China.
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Casal CAD, Silva MOD, Costa IB, Araújo EDC, Corvelo TCDO. Molecular detection of Treponema pallidum sp. pallidum in blood samples of VDRL-seroreactive women with lethal pregnancy outcomes: a retrospective observational study in northern Brazil. Rev Soc Bras Med Trop 2011; 44:451-6. [PMID: 21789353 DOI: 10.1590/s0037-86822011005000047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 02/17/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Although control measures of maternal and congenital syphilis are available in Brazil, difficulties exist within the healthcare network in providing a laboratory diagnosis of the infection during the prenatal period. The objective of this study was to confirm the presence of Treponema pallidum by PCR in women with positive VDRL serology and lethal pregnancy outcomes, i.e., abortion, stillbirth and neonatal death. METHODS A retrospective study was conducted on VDRLseroreactive women with lethal pregnancy outcomes admitted to the Fundação Santa Casa de Misericórdia do Pará (FSCM-PA) between January and July 2004. Serum samples and DNA from whole blood were obtained at the time of screening by the VDRL test. These samples were analyzed by IgG ELISA, IgM FTA-Abs and simple PCR (polA). RESULTS During the study period, 0.7% (36/4,912) of women with lethal pregnancy outcomes presented a positive VDRL test. The polAgene was amplified in 72.7% (24/33) of these women, with 55.6% (20/36) and 94.4% (34/36) presenting IgM and IgG antibodies against T. pallidum, respectively. Comparison of these results showed a significant difference, with agreement between the PCR and IgM FTA-Abs results, suggesting that maternal syphilis was an active infection. No basic cause of death of the conceptus was reported in 97.2% (35/36) of cases. Among women who were submitted to the VDRL test during the prenatal period, only four of the nine seroreactive patients underwent treatment. CONCLUSIONS The high frequency of syphilis in the group studied indicates the fragility of the service of infection diagnosis, treatment and monitoring, compromising epidemiological control.
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Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2011; 11:684-91. [PMID: 21683653 DOI: 10.1016/s1473-3099(11)70104-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND About 2·1 million pregnant women have active syphilis every year. Without screening and treatment, 69% of these women will have an adverse outcome of pregnancy. The objectives of this study were to review the literature systematically to determine the effectiveness of screening interventions to prevent congenital syphilis and other adverse pregnancy outcomes. METHODS We searched four electronic databases and selected studies to examine evidence for effectiveness of interventions on three outcomes: increased uptake of syphilis testing, increased treatment rates, and reduction in adverse pregnancy outcomes. We used fixed effects meta-analysis to estimate pooled relative risks if no or little evidence of heterogeneity between trials existed. FINDINGS Ten studies met the inclusion criteria, including two randomised trials. Only two studies aimed to encourage women to seek care earlier in pregnancy. Nine studies included decentralisation of screening and treatment. The effects of the interventions on uptake of testing for antenatal syphilis and receiving at least one dose of penicillin were variable and could not be combined statistically. Study interventions were associated with a reduction in perinatal death (pooled risk ratio [RR] from three studies 0·46, 95% CI 0·26-0·82) and stillbirth (pooled RR from three studies 0·42, 95% CI 0·19-0·93). The incidence of congenital syphilis was reduced in all four studies that measured this outcome with heterogeneous results. INTERPRETATION Interventions to improve the coverage and effect of screening programmes for antenatal syphilis could reduce the syphilis-attributable incidence of stillbirth and perinatal death by 50%. The resources required to roll out antenatal screening programmes would be a worthwhile investment for reduction of adverse pregnancy outcomes and improvement of neonatal and child survival. FUNDING None.
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Benzaken AS, Sabidó M, Galban E, Pedroza V, Araújo AJG, Peeling RW, Mabey D. Field performance of a rapid point-of-care diagnostic test for antenatal syphilis screening in the Amazon region, Brazil. Int J STD AIDS 2011; 22:15-8. [PMID: 21364061 DOI: 10.1258/ijsa.2010.010145] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated an immunochromatographic point-of-care (POC) syphilis test in 712 pregnant women under field conditions in remote communities of the Amazon region (Brazil), and identified risk factors for syphilis. Women were screened by POC test using whole blood obtained by fingerprick, the fluorescent treponemal antibody absorption (FTA-Abs) test as the gold standard and the Venereal Diseases Research Laboratory (VDRL) test to determine test performance in active syphilis. Multivariate analysis was conducted to identify factors associated with syphilis infection. Among women, 2.2% had syphilis (positive FTA-Abs) and 0.8% active syphilis (FTA-Abs and VDRL positive). In all, 2.2% of samples were positive by the POC test. The sensitivity, specificity, positive and negative predictive values were 62.5% (95% confidence interval [CI]: 38.6-81.5), 99.1% (95% CI: 98.1-99.6), 62.5% (95% CI: 38.6-81.5) and 99.1% (95% CI: 98.1-99.6), respectively. The POC test identified 62.5% (10/16) of syphilis cases, 66.7% (4/6) of active syphilis cases and all high-titre syphilis cases (VDRL > 1:8). Older age was associated with syphilis infection. The rapid test performed moderately well as a screening tool for low-risk populations. This combined with on-site testing and same day treatment could expand antenatal syphilis screening programmes in distant communities characterized by difficult access to antenatal services and infrequent clinical follow-up visits.
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Blencowe H, Cousens S, Kamb M, Berman S, Lawn JE. Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality. BMC Public Health 2011; 11 Suppl 3:S9. [PMID: 21501460 PMCID: PMC3231915 DOI: 10.1186/1471-2458-11-s3-s9] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity. OBJECTIVES This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4 MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality. METHODS We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken. RESULTS Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 - 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4 MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 - 90%) (8 studies), a 64% reduction in preterm delivery (95% c.i. 53 - 73%) (7 studies) and an 80% reduction in neonatal deaths (95% c.i. 68 - 87%) (5 studies). Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong. CONCLUSION Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required.
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Affiliation(s)
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mary Kamb
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, USA
| | - Stuart Berman
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, USA
| | - Joy E Lawn
- Saving Newborn Lives/Save the Children-USA, South Africa
- Health Systems Strengthening Unit, Medical Research Council, South Africa
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Novel point-of-care test for simultaneous detection of nontreponemal and treponemal antibodies in patients with syphilis. J Clin Microbiol 2010; 48:4615-9. [PMID: 20881177 DOI: 10.1128/jcm.00624-10] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe a point-of-care immunochromatographic test for the simultaneous detection of both nontreponemal and treponemal antibodies in the sera of patients with syphilis that acts as both a screening and a confirmatory test. A total of 1,601 banked serum samples were examined by the dual test, and the results were compared to those obtained using a quantitative rapid plasma reagin (RPR) test and the Treponema pallidum passive particle agglutination (TP-PA) assay. Compared to the RPR test, the reactive concordance of the dual test nontreponemal line was 98.4% when the RPR titers of sera were ≥1:2 and the nonreactive concordance was 98.6%. Compared to the TP-PA assay, the reactive and nonreactive concordances of the treponemal line were 96.5% and 95.5%, respectively. These results indicate that the dual test could be used for the serological diagnosis of syphilis in primary health care clinics or resource-poor settings and therefore improve rates of treatment where patients may fail to return for their laboratory results.
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Tucker JD, Bu J, Brown LB, Yin YP, Chen XS, Cohen MS. Accelerating worldwide syphilis screening through rapid testing: a systematic review. THE LANCET. INFECTIOUS DISEASES 2010; 10:381-6. [DOI: 10.1016/s1473-3099(10)70092-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Krüger C, Malleyeck I. Congenital syphilis: still a serious, under-diagnosed threat for children in resource-poor countries. World J Pediatr 2010; 6:125-31. [PMID: 20490768 DOI: 10.1007/s12519-010-0028-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 10/08/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND With 700,000 to 1.5 million new cases annually, congenital syphilis remains a major infectious cause of morbidity and mortality in neonates, infants and children in resource-poor countries. We therefore analyzed the extent of congenital syphilis in the pediatric patient population at our rural hospital in Tanzania. METHODS For this retrospective analysis, from January 1, 1998 to August 31, 2000, all cases of congenital syphilis were collected from the medical records of the neonatal and pediatric department at Haydom Lutheran Hospital in rural northern Tanzania. Age, sex, weight, clinical signs and symptoms, venereal disease research laboratory (VDRL) results of mother and/or child, hemoglobin concentration, treatment, and outcome were recorded and analyzed. RESULTS Fourteen neonates and infants were included. The earlier the diagnosis, the more it rested on maternal data because the presentation of neonatal congenital syphilis resembled neonatal sepsis. Syphilitic skin lesions were only seen in the post-neonatal age group. VDRL results were positive in 11 of the 14 mothers, and in 4 of the infants. Anemia was common in older infants. No patient showed signs of central nervous system involvement. Two patients died, and the remaining were cured after standard treatment with procaine penicillin. CONCLUSIONS Highlighting the variable picture of congenital syphilis, this report demonstrates how difficult it is to make a correct diagnosis by solely history and clinical presentation in a resource-poor setting. Hence false-positive and false-negative diagnoses are common, and clinicians have to maintain a high index of suspicion in diagnosing congenital syphilis. Therefore, an important approach to control and finally eliminate congenital syphilis as a major public health problem will be universal on-site syphilis screening of all pregnant women at their first antenatal visit and immediate treatment for those who test positive.
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Affiliation(s)
- Carsten Krüger
- Department of Pediatrics, St. Franziskus Hospital, Ahlen, Germany.
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