Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #113079

Pablo Montoya, MD, MPH¹, Paula E. Brentlinger, MD, MPH², Florencia Floriano¹, and Stephen Gloyd, MD, MPH³. (1) Health Alliance International, CP 583, Beira, Mozambique, 01125882501360, pablom@teledata.mz, (2) International Health Program, Department of Health Services, University of Washington, Box 354809, University of Washington, Seattle, WA 98195, (3) Health Services/International Health, University of Washington, 1959 NE Pacific Street, H-660 P.O. Box 357660, Seattle, WA 98195-7660

Background and purpose: Untreated syphilis results in pregnancy loss and congenital syphilis and increases transmission of the human immunodeficiency virus (HIV). Lack of laboratory services, delayed diagnosis and questions about the diagnostic accuracy of existing screening methods limit the effectiveness of syphilis control programs in developing countries with high syphilis prevalence. The purpose of the study was to assess the diagnostic accuracy of an Immunochromatographic Strip (ICS) test compared with the Rapid Plasma Reagin (RPR) for the detection of syphilis in pregnancy.

Methods: We recruited 4789 women at their first antenatal visit in 6 health facilities in Central Mozambique. All first pregnant women had ICS, RPR, and TPHA done at their first prenatal visit. Subgroup comparisons by HIV and malaria status and by reference laboratory and field results were also made.

Main Results: For active syphilis the sensitivity of the ICS was 95.3% (92.6%, 97.2%) at the reference lab, and 84.1% (79.3%, 87.1%) at the health facility. The sensitivity of the RPR at the health facility was 70.7% (65.5%, 74.9%). The sensitivity of the ICS for active syphilis was 8% lower in the reference lab in the presence of malaria (p=0.01). There were no differences in the accuracy of the test according to the HIV status.

Conclusions: The diagnostic accuracy of the ICS compared favorably with the TPHA (part of the gold standard) at the reference lab, but was lower at the health facilities. The ICS outperformed the RPR in all comparisons (p<0.001). The use of the ICS in Mozambique and comparable settings may improve the diagnosis of syphilis in health facilities, both with and without laboratories.

Learning Objectives:

• Recognize the importance of prenatal syphilis screening in Africa
• Evaluate the cost-effectiveness of alternative prenatal syphilis screening strategies

Keywords: Syphilis Screening, Prenatal Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.