A multifaceted intervention to improve syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cluster randomised controlled trial

Abstract

Summary Background Despite international recommendations, coverage of syphilis testing in pregnant women and treatment of those found seropositive remains limited in sub-Saharan Africa. We assessed whether combining the provision of supplies with a behavioural intervention was more effective than providing supplies only, to improve syphilis screening and treatment during antenatal care. Methods In this 18-month, cluster randomised controlled trial, we randomly assigned (1:1) 26 urban antenatal care clinics in Kinshasa, Democratic Republic of the Congo, and Lusaka, Zambia, to receive a behavioural intervention (opinion leader selection, academic detailing visits, reminders, audits and feedback, and supportive supervision) plus supplies for syphilis testing and treatment (intervention group) or to receive supplies only (control group). The primary outcomes were proportion of pregnant women who had syphilis screening out of the total who attended the clinic; and the proportion of women who had treatment with benzathine benzylpenicillin out of those who tested positive for syphilis at their first antenatal care visit. This trial is registered at ClinicalTrials.gov , number NCT02353117 . Findings The 18-month study period was Feb 1, 2016, to July 14, 2017. 18 357 women were enrolled at the 13 intervention clinics and 17 679 women were enrolled at the 13 control clinics at their first antenatal care visit. Syphilis screening was done in a median of 99·9% (IQR 99·0–100·0) of women in the intervention clinics and 93·8% (85·0–98·9) in the control clinics (absolute difference 6·1% [95% CI 1·1–14·1]; p=0·00092). Syphilis treatment at the first visit was done in a median of 100% (IQR 99·7–100·0) of seropositive women in intervention clinics and 43·2% (2·6–83·2) of seropositive women in control clinics (absolute difference 56·8% [12·8–99·0]; p=0·0028). Interpretation A behavioural intervention, together with the provision of supplies, can lead to more than 95% of women being screened and treated for syphilis. The sole provision of supplies is sufficient to reach such levels of screening coverage but is not sufficient to ensure high levels of treatment. Funding Bill & Melinda Gates Foundation.

Health facility readiness and provider knowledge as correlates of adequate diagnosis and management of pre-eclampsia in Kinshasa, Democratic Republic of Congo

“…The study also highlighted the need for addressing contradictions in the DRC's national guidelines regarding the place of availability of essential drugs and enhancing the availability of supplies and their utilization. In a recently published cluster randomized controlled trial in Kinshasa and Lusaka (Zambia), Althabe et al showed that a combination of provision of supplies with a behavioral intervention including supportive supervision, the use of opinion leaders, reminders, audit, and feedback, improved the diagnosis and management of maternal conditions such as syphilis [59]. A similar approach could be implemented to improve the quality of care for pre-eclampsia in Kinshasa.…”

A condom uterine balloon device among referral facilities in Dar Es Salaam: an assessment of perceptions, barriers and facilitators one year after implementation

“…In-country champions could also be utilized to provide encouragement and support as well as mentorship. Previous research has demonstrated the importance of ongoing dissemination of the findings to various actors in different levels of the health care system in order to ensure and maintain stakeholder buy-in for health programs in rural cities [21].…”

“…While the ESM-UBT device is both low cost and efficacious [13][14][15], changing health care provider behavior can be complex and challenging [16][17][18][19][20]. There is, however, a growing body of literature that seeks to identify implementation approaches that drive optimal provider performance and quality overall care [16,[18][19][20][21][22]. Tailoring interventions to address known determinants of practice has been shown to influence health care provider practice [23][24][25][26] and a number of authors have emphasized the importance of identifying barriers in order to strengthen implementation efforts [16,17,26,27].…”

Evaluating coverage of maternal syphilis screening and treatment within antenatal care to guide service improvements for prevention of congenital syphilis in Countdown 2030 Countries

“…We encourage countries to improve ANC syphilis screening and treatment coverage and to prioritize the use of the UNAIDS GAM system to capture and monitor progress towards EMTCT [7]. Information on the downstream effects of missed opportunities to screen and treat women for syphilis during ANC provide a rich source of evidence for scale up [23,24].…”