Background Assuring the quality of a diagnostic test is important in healthcare. For syphilis testing, this includes proficiency testing of previously well characterised serum samples by health workers blinded to the results of characterisation. As part of a study on the feasibility of using a Point of Care (POC) rapid test devise for syphilis testing in rural antenatal settings, proficiency testing material prepared in a referral laboratory using Dried Tube Specimens (DTS) was sent for testing by the nurses/midwifes in these rural settings.

Methods Five well characterised DTS (one high RPR reactive, three low RPR reactives and one RPR non-reactive) were sent for on-site testing in eight rural antenatal facilities in Eastern Ghana. Training of nurses/midwifes in reconstituting the DTS and their testing and reporting was previously carried out. An instruction leaflet was enclosed in each batch of the DTS. Four rounds of the testing were carried out at monthly intervals.

Results Seven out of the eight facilities correctly reported results of the DTS for all the rounds. One facility however reported all specimens as negative at the first round. On-site investigation showed that the nurse running the antenatal clinic who normally wore reading glasses had lost them. On replacing her glasses and going through an on-site re-training, she obtained 100% in subsequent rounds of testing.

Conclusion Syphilis proficiency testing in rural facilities carried out by non-laboratory personnel using DTS is feasible. Initial training with on-site monitoring is important to detect any testing problems.