Background Syphilis is still a major cause of morbidity and mortality in women and children. In Tanzania syphilis was shown to cause adverse pregnancy outcomes in 49% and stillbirth in 25% of pregnant women with high titre syphilis. Although syphilis screening and treatment is a national policy and is one of the most cost effective interventions, its implementation on a large scale is limited. Lack of a simple and rapid point of care diagnostic test for syphilis has been suggested as one of the major reasons for this limitation. We implemented a demonstration project in Geita district, Tanzania to assess the feasibility of introducing a rapid diagnostic test in antenatal care services. The objectives of the project were to determine (1) the feasibility of increasing access to antenatal syphilis screening using same day testing and treatment strategy, and (2) the acceptability of introducing rapid syphilis testing to service providers and clients.
Methods A health facility based baseline survey was carried out using a structured questionnaire to determine syphilis uptake before rapid test introduction. A team of four district trainers and supervisors were trained on how to perform the test, on quality assurance and stock management. Health workers were also trained on how to perform the test, quality assurance and stock management. Then rapid tests were introduced in all health facilities and qualitative data were collected to assess acceptability of the test. The uptake of syphilis testing and treatment among pregnant women in 3 months before and after rapid test introduction were compared using χ2 test.
Results Numbers of pregnant women tested in the 3 months after rapid test introduction were significantly higher than those tested before its introduction in the same period (p<0.01). Similarly a significantly higher number of syphilis positive women were treated compared to those treated before test introduction (p<0.01) see Abstract S2.1 figure 1. The same day testing and treatment strategy enabled 95% of women testing positive to be treated at their first visit. The rapid test was acceptable to both service providers and clients.
Conclusions Introduction of rapid syphilis tests has made it possible to implement national policy for screening pregnant women in Tanzania. Increasing access to screening and treatment will prevent many perinatal deaths.
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