PT  - JOURNAL ARTICLE
AU  - A S Benzaken
AU  - M Sabidó
AU  - E G Galban
AU  - V Pedroza
AU  - F Vasquez
AU  - A Araújo
AU  - R W Peeling
AU  - P Mayaud
TI  - Field evaluation of the performance and testing costs of a rapid point-of-care test for syphilis in a red-light district of Manaus, Brazil
AID  - 10.1136/sti.2007.029462
DP  - 2008 Aug 01
TA  - Sexually Transmitted Infections
PG  - 297--302
VI  - 84
IP  - 4
4099  - http://sti.bmj.com/content/84/4/297.short
4100  - http://sti.bmj.com/content/84/4/297.full
SO  - Sex Transm Infect2008 Aug 01; 84
AB  - Objectives: To assess the performance, usefulness and cost of a rapid treponemal antibody assay (VisiTect Syphilis) to detect syphilis in high risk populations.Methods: People who attended STI clinics in Manaus, Brazil, were screened for syphilis using the fluorescent treponemal antibody absorption (FTA-Abs) test and a non-treponemal test (Venereal Diseases Research Laboratory (VDRL)), and for HIV. Finger prick blood samples were tested with VisiTect Syphilis. The rapid test was evaluated against the reference FTA-Abs and for its usefulness in detecting active syphilis (FTA-Abs and VDRL positive). Operational performance was assessed through providers’ and patients’ interviews. An economic evaluation was conducted from the provider’s perspective.Results: 510 patients (60% men) were enrolled, of whom 13 (2.5%) were HIV-1 seropositive. Syphilis prevalence (FTA-Abs) was 18% and active syphilis prevalence was 7.5%. 11% (57/506) of samples were positive by VisiTect. The sensitivity, specificity, positive and negative predictive values of VisiTect Syphilis were 57% (95% CI 45.8 to 66.7), 99% (95% CI 97.0 to 99.6), 91% (95% CI 80.0 to 96.7) and 91% (95% CI 88.0 to 93.5), respectively. VisiTect Syphilis identified 79% (30/38) of active syphilis cases. The cost per case of syphilis was $16.8 for VDRL, $33.2 for low cost and $56.3 for high cost VisiTect Syphilis; the cost per case of active syphilis was $21.3, $57.5 and $97.6, respectively. Patients identified finger prick pain and preference for venous blood collection as minor barriers to test use.Conclusion: VisiTect Syphilis had low sensitivity in field use and was less cost effective than conventional VDRL. However, rapid and correct identification of a high proportion of active syphilis cases combined with operational characteristics suggest a role in high risk populations.