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Impact of on-site testing for maternal syphilis on treatment delays, treatment rates, and perinatal mortality in rural South Africa: a randomised controlled trial
  1. L Myer1,
  2. D Wilkinson2,
  3. C Lombard3,
  4. K Zuma3,
  5. K Rotchford4,
  6. S S Abdool Karim5
  1. 1School of Public Health and Primary Health Care, University of Cape Town, and HIV Prevention and Vaccine Research Unit, Medical Research Council, South Africa
  2. 2South Australian Centre for Rural and Remote Health, Adelaide University, and University of South Australia, Australia
  3. 3Biostatistics Unit, Medical Research Council, South Africa
  4. 4Medical Research Council, South Africa
  5. 5University of Natal, South Africa
  1. Correspondence to:
 Landon Myer, Department of Public Health, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa; 


Background: Syphilis remains a significant cause of preventable perinatal death in developing countries, with many women remaining untested and thus untreated. Syphilis testing in the clinic (on-site testing) may be a useful strategy to overcome this. We studied the impact of on-site syphilis testing on treatment delays and rates, and perinatal mortality.

Methods: We conducted a cluster randomised controlled trial among seven pairs of primary healthcare clinics in rural South Africa, comparing on-site testing complemented by laboratory confirmation versus laboratory testing alone. Intervention clinics used the on-site test conducted by primary care nurses, with results and treatment available within an hour. Control clinics sent blood samples to the provincial laboratory, with results returned 2 weeks later.

Results: Of 7134 women seeking antenatal care with available test results, 793 (11.1%) tested positive for syphilis. Women at intervention clinics completed treatment 16 days sooner on average (95% confidence interval: 11 to 21), though there was no significant difference in the proportion receiving adequate treatment at intervention (64%) and control (69%) clinics. There was also no significant difference in the proportion experiencing perinatal loss (3.3% v 5.1%; adjusted risk difference: −0.9%; 95% CI −4.4 to 2.7).

Conclusions: Despite reducing treatment delays, the addition of on-site syphilis testing to existing laboratory testing services did not lead to higher treatment rates or reduce perinatal mortality. However on-site testing for syphilis may remain an important option for improving antenatal care in settings where laboratory facilities are not available.

  • maternal syphilis
  • perinatal mortality
  • South Africa
  • randomised controlled trial

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