Background In May 2012, a simultaneous triple point-of-care screening programme for syphilis, hepatitis B (HBV) and HIV was integrated in antenatal services in rural Guatemala. The programme included screening for pregnant women with mobile outreach teams, promotion through community networks, partner notification, and linkage to care. Our aim was to evaluate its feasibility and effectiveness in increasing testing uptake, case detection and referrals for positive cases.
Methods A network of over 200 midwives and community volunteers promoted testing and recruited pregnant women through community IEC campaigns. Nurses from three mobile outreach teams, two health posts, and the district health centre offered counselling and triple screening by fingerprick. Syphilis cases were treated on-site. HIV and HBV were referred with accompaniment to the tertiary hospital for care and prevention of mother to child transmission. Testing uptake was compared with the 8-month period prior to implementation of the programme.
Results In 8 months, 978 women sought prenatal services; 65% were screened for HIV and syphilis and 62% for HBV. Testing uptake increased 209%/30% from baseline for HIV/syphilis (p < 0.001). 29% were screened during the first trimester. Six cases of syphilis were detected and treated (0.95%); two cases of HIV (0.32%) were detected and initiated prophylaxis/treatment; and 0 cases of HBV. All of these cases were identified by the rural outreach teams or health posts. Seven women notified their partners (5 for syphilis, 2 for HIV) yet only 1 partner was tested, resulting positive. Three children were born with suspected congenital syphilis and all three died.
Conclusions This outreach programme shows the feasibility of simultaneous screening for three infections in rural Guatemala and its effectiveness in increasing screening coverage, case detection, and access to treatment services. Further efforts should work to improve earlier detection, results of partner notification, and adverse outcomes due to congenital syphilis.
- mobile outreach
- simultaneous triple point-of-care screening