Introduction Quality of syphilis testing is a critical component of effective STI control programs, including elimination of mother-to-child transmission of HIV and syphilis. To understand syphilis testing policies and practices in the Region of the Americas, the Pan American Health Organisation (PAHO) surveyed directors of national/regional reference and lower-level laboratories in its 35 member states.

Methods In 2014, PAHO identified directors of national/regional reference laboratories and a convenience sample of lower-level laboratories providing clinical diagnostic testing. An electronically-administered survey was used to collect data on tests and algorithms used, quality assurance/quality control (QA/QC) systems, and challenges faced.

Results The 69 participating laboratories, representing 30 (86%) PAHO member states, were from Central America (n=22, 32%), the Caribbean (n=15, 22%), the Andean (n=16, 23%) and Southern Cone nations (n=14, 20%), and North America (n=2, 3%). Of the 69 laboratories, 41 (59%) were national or regional reference facilities and 28 (41%) were lower-level facilities (25 public and 3 private). Overall 49 (71%) laboratories (80% reference, 57% other) reported using a nationally recommended algorithm for syphilis testing, primarily a non-treponemal screening test and treponemal confirmatory test (n=35, 71%). Ten laboratories (7 reference, 3 other) used an algorithm that did not employ confirmatory testing. Twenty-eight (41%) laboratories reported using rapid tests (49% reference, 29% other). Thirty-three (48%) could provide results to clinics within 24 hours. Some type of QA/QC program was reported by 60 (87%) laboratories (88% reference, 86% other). Of the 69 laboratories, 83% used daily controls, 64% routinely maintained equipment, 70% participated in an external QA program, and 65% used standard operating procedures. Frequently reported challenges were limited opportunities for staff training (73%), insufficient equipment (24%) and stock outs of reagents and other supplies (55%).

Conclusion Many reference and clinical laboratories in the region still face challenges in ensuring quality syphilis testing. Many lack adequately trained staff, and some lack sufficient supplies for routine syphilis testing. Several have not yet adopted basic QA/QC practices needed to ensure quality testing. Less than half of the laboratories have adopted rapid testing strategies.