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Screening pregnant women for HIV and syphilis is a critical component of national programming to achieve elimination of mother to child transmission (EMTCT) for the two diseases. Many countries have well-resourced programmes for HIV screening in pregnant women and key populations (men who have sex with men and sex workers), but screening for syphilis in these same risk groups is seldom centralised and often falls within the responsibilities but outside the priorities of reproductive health, antenatal care and sexually transmitted infection (STI) control programmes. The tragedy of babies avoiding HIV and dying of syphilis and the lack of progress in Africa in congenital syphilis elimination despite tremendous successes in EMTCT for HIV has once again reminded us of the need to re-examine this situation.1 2
In this issue, Obure et al describes a comparative analysis of costs of single versus dual rapid diagnostic tests for HIV and syphilis in the cities of Bogota and Cali in Columbia.3 The authors report higher costs associated with the use of rapid dual HIV/syphilis tests compared to single rapid HIV and syphilis tests. At baseline, the Columbia purchase price of the rapid dual test kits was more expensive than the single test kits; US$3.62 for the dual test versus US$2.26 for the two single tests (US$1.03 for single HIV and US$1.23 for syphilis). A comprehensive diagnostic brief of rapid dual tests has recently cited the average cost of US$1.50 per test kit.4 Pan American Health Organisation's (PAHO) Strategic Fund is offering the same rapid dual test kits for US$1.50 per test.
In the selection of diagnostic tests, country …
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