Introduction Most women in Colombia receive antenatal care (ANC), but goals for the reduction of congenital syphilis (CS) have not been met. In 2015 Cali had an incidence of 3.0 cases of CS per 1000 births.Point of care testing (POC) has proven cost-effective, and since 2015 it is now recommended by the Colombian Ministry of Health Guidelines. Nevertheless, POC for gestational syphilis (GS) has not been implemented in ANC. We sought to test the feasibility of POC and identify barriers to its implementation in Floralia, a public, primary healthcare centre in Cali.
Methods During a three-month period, we observed routine ANC in Floralia and offered women on-site rapid tests (RT) for syphilis. Process measures were compared with data from the clinical charts (CC) of women seen in 2015. Patients and administrators were interviewed and asked to describe ANC, syphilis screening procedures, and to identify opportunities for improvement.
Results 55 women were offered POC testing, 42 agreed to participate and were screened. 55 CC from 2016, and 123 CC from 2015, were reviewed. The median gestational age at which women sought health care was eight weeks. The first trimester of pregnancy had the highest percentage of women screened for GS: 97% were screened in 2015, and 100% were screened in 2016. Changes to screening procedures were hindered by existing contracts with insurance companies (IC); they determine what tests can be ordered and who can order them. Administrative procedures lead to missed opportunities for screening and treatment.Two women (1.6%) from the 2015 group were diagnosed with GS, and three (5.4%) were diagnosed during the intervention. POC testing allowed us to treat GS on the same day of the positive result, while using routine testing methods took 6 to 24 days.
Conclusion Diffusion of the national guidelines for GS has been insufficient to control GS and CS: There is still confusion among health care workers, and contracts with IC do not include RT. POC for syphilis can be a part of ANC, but barriers need to be addressed before implementation.
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