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Assessing stakeholder perceptions of the acceptability and feasibility of national scale-up for a dual HIV/syphilis rapid diagnostic test in Malawi
  1. Brandy L Peterson Maddox1,
  2. Shauntā S Wright1,
  3. Hazel Namadingo2,
  4. Virginia B Bowen1,
  5. Geoffrey A Chipungu3,
  6. Mary L Kamb1
  1. 1 Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2 Malawi Epidemiology Intervention Research Unit, London School of Hygiene and Tropical Medicine, Lilongwe, Malawi
  3. 3 Division of Global HIV and Tuberculosis-Malawi, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Brandy L Peterson Maddox, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; ftn6{at}


Objectives The WHO recommends pregnant women receive both HIV and syphilis testing at their first antenatal care visit, as untreated maternal infections can lead to severe, adverse pregnancy outcomes. One strategy for increasing testing for both HIV and syphilis is the use of point-of-care (rapid) diagnostic tests that are simple, proven effective and inexpensive. In Malawi, pregnant women routinely receive HIV testing, but only 10% are tested for syphilis at their first antenatal care visit. This evaluation explores stakeholder perceptions of a novel, dual HIV/syphilis rapid diagnostic test and potential barriers to national scale-up of the dual test in Malawi.

Methods During June and July 2015, we conducted 15 semistructured interviews with 25 healthcare workers, laboratorians, Ministry of Health leaders and partner agency representatives working in prevention of mother-to-child transmission in Malawi. We asked stakeholders about the importance of a dual rapid diagnostic test, concerns using and procuring the dual test and recommendations for national expansion.

Results Stakeholders viewed the test favourably, citing the importance of a dual rapid test in preventing missed opportunities for syphilis diagnosis and treatment, improving infant outcomes and increasing syphilis testing coverage. Primary technical concerns were about the additional procedural steps needed to perform the test, the possibility that testers may not adhere to required waiting times before interpreting results and difficulty reading and interpreting test results. Stakeholders thought national scale-up would require demonstration of cost-savings, uniform coordination, revisions to testing guidelines and algorithms, training of testers and a reliable supply chain.

Conclusions Stakeholders largely support implementation of a dual HIV/syphilis rapid diagnostic test as a feasible alternative to current antenatal testing. Scale-up will require addressing perceived barriers; negotiating changes to existing algorithms and guidelines; and Ministry of Health approval and funding to support training of staff and procurement of supplies.

  • perinatal infection
  • syphilis
  • HIV testing
  • service delivery
  • qualitative research

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  • Handling editor Claudia S Estcourt

  • Contributors BLPM, SSW, VBB and MLK conceived and designed the study. BLPM and SSW developed the data collection tools. BLPM, VBB, GAC and MLK identified and recruited participants. BLPM and HN collected the data. BLPM, HN, GAC and SSW transcribed the data. BLPM and SSW analysed the data and drafted the first version of this article. All authors critically reviewed and provided intellectual input on the manuscript and approved the final draft for publication.

  • Competing interests None declared.

  • Ethics approval This study received ethical approval from the Malawi Ministry of Health and non-research determination from the U.S. Centers for Disease Control and Prevention. Ethical review was conducted and approved by the Malawi Institutional Review Board from the National Health Sciences Research Committee (NHSRC), protocol no. 1251.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement Data from this study were presented at the STD Prevention Conference, Atlanta, GA 2016; interested parties may contact the corresponding author to view the presentation.

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