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APHA Scientific Session and Event Listing

Improving syphilis diagnosis and treatment: Introduction of rapid strip tests into Bolivian antenatal care services

Sandra Garcia, ScD, ScM1, Freddy Tinajeros, MPH2, Kara Richmond, MPH3, Rita Revollo, MD2, Claudia Diaz, PhD1, Dan Grossman4, Carol Levin, PhD5, Matthew Steele, PhD5, and Eileen A. Yam, MPH1. (1) Population Council Regional Office for Latin America and the Caribbean, One Dag Hammarskjold Plaza, New York, NY 01070, 52 55 5999 8630, eyam@popcouncil.org.mx, (2) Population Council, Calle F. Guachalla #342, Edificio Victor, 3rd Floor, La Paz, Bolivia, (3) Independent consultant, 712 La Veta Dr. NE, Albuquerque, NM 87108, (4) Ibis Reproductive Health, UCSF 3333 California Street, Suite 335, San Francisco, CA 94143-0744, (5) PATH, 1455 NW Leary Way, Seattle, WA 98107

BACKGROUND: Since 1998, syphilis diagnosis and treatment has been a part of government-funded antenatal care (ANC) services in Bolivia. Yet only 19.7% of pregnant women received syphilis testing in 2002. We assessed the feasibility and acceptability of using rapid syphilis strip tests (Abbott Determine Syphilis TP) for improving diagnosis and treatment among pregnant women. METHODS: Between January 2004 and April 2005, we invited women seeking antenatal care at 37 rural health centers and four maternity hospitals to participate. The number of women tested, treated, and partners treated; responses to feasibility and acceptability questionnaires; and test performance characteristics were ascertained. RESULTS: 11618 women were tested; 577 women (5.0%) tested positive; 538 (93.2%) received a single dose of penicillin; 470 (81.4%) received three doses; and 376 (76.2%) of identified partners received at least one dose. Of questionnaire responders, 11562 participants (99.6%), 48 clinicians (100.0%), and 10 laboratory technicians (90.9%) agreed that the syphilis strip test should be routinely used for ANC services. Using RPR and TPPA confirmation performed in a reference laboratory as the “gold standard,” the strip test conducted in urban hospitals showed a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 91.8% (95% confidence interval: 88.4-94.5), 98.5% (98.2-98.8), 71.0% (66.6-75.2), and 99.7% (99.5-99.8) versus 75.7% (70.8-80.2), 99.0% (98.9-99.3), 76.9% (72.0-81.3), and 99.0% (98.8-99.2) respectively for RPR performed at the hospital. CONCLUSION: Introduction of strip tests for syphilis screening in antenatal care services was feasible and acceptable, and high testing and treatment rates resulted.

Learning Objectives:

Keywords: Syphilis Screening, Technology

Presenting author's disclosure statement:

Not Answered

Handout (.ppt format, 30182.5 kb)

Maternal Health

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA