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Symposium 2: Rapid tests as tools to transform policy, strengthen health systems and save lives (sponsored by WHO/TDR and the London school of hygiene and tropical medicine)
S2.3 Screening high-risk populations using rapid syphilis tests: the importance of social and cultural contexts
  1. X S Chen1,
  2. Y P Yin1,
  3. W H Wei1,
  4. R Peeling2
  1. 1National Center for STD Control, China CDC, Nanjing, China
  2. 2London School of Hygiene & Tropical Medicine, London, UK

Abstract

Background Syphilis has made a dramatic resurgence in China during the past 2 decades with an increasing prevalence in high-risk groups. Screening of syphilis in the populations is critical for control of the disease.

Methods A rapid syphilis test (RST) was introduced into STD services among patients attending STD clinics and existing outreach services to female sex workers (FSW) in Liuzhou and Jiangmen, China to test the feasibility of same-day test and treatment (STAT) and same-day test and referral (STAR) strategies. The STAT and STAR rates were evaluated regarding the different STD providers and outreach teams, respectively.

Results Of 7283 patients from 3 STD clinics in Liuzhou—one public health clinic, one private reproductive health clinic and one general hospital clinic who were screened with a non-treponemal test, TRUST, and RST for syphilis, 291 (4.0%) had active syphilis, but only 69.8% of infected cases accepted the STAT. The acceptance rate was different between clinics, with 54.2% in public health clinic, 71.8% in reproductive health clinic and 100.0% in general hospital clinic. During the outreach services provided by the CDC intervention team (CIT), STD clinic team (SCT) and reproductive health clinic team (RCT), 75% of FSWs accepted to be tested with RST in sex work venues. Of 2780 FSWs screened with RST, 199 (7.2%) were positive and were referred to designated clinics for further testing and treatment. However, success in referring RST positive FSWs to designated clinics were significantly different between outreach teams. RCT had the highest referral rate (85.7%) followed by SCT (70.6%) and CIT (26.7%). Focus groups discussions among providers and high-risk populations regarding the introduction of RST indicated that social and cultural contexts were related to the successful introduction of RST among these populations. Trust of the target population in the clinics and outreach team was related to the acceptability of STAT and STAR. Belief in the results of a free RST test, confidentiality of syphilis status, social stigma, medical cost at the designated clinics for further test and treatment, and time spent for clinic visit were the main concerns of FSWs, especially in the referral advice.

Conclusions Feasibility in introduction of STAT and STAR among high-risk groups is encouraging but the barriers still exist. Social and cultural contexts are important and should be considered when RST is introduced as one of strategies for prevention and control of syphilis in China.

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