Introducing onsite antenatal syphilis screening in Burkina Faso: implementation and evaluation of a feasibility intervention tailored to a local context

Abstract

BackgroundAlthough the advantages of introducing point of care testing for syphilis in antenatal care (ANC) are well documented, there is little evidence on how to address structural issues within health systems. A better understanding of how these interventions work in a range of settings and contexts is needed in order to overcome bottlenecks at health system level. To better understand the relationships between implementation and context we developed and implemented an intervention focused on integrating a rapid screening test for syphilis in ANC services in rural primary health care facilities in Burkina Faso. This manuscript describes the intervention and reports on feasibility and acceptability of the intervention, the facilitators and barriers to the implementation of this intervention and the likelihood that point of care test for syphilis will become routinely incorporated in practice.MethodsIn Kaya Health and Demographic Surveillance System (Kaya HDSS), all 7 primary healthcare facilities were selected for intervention in 2013. A participatory approach was used to design and implement an antenatal syphilis screening intervention. The Normalization Process Model (NPM) proposed by May et al. was adapted in order to identify barriers and facilitators and to explore the likelihood to become routinely incorporated in practice. Registers, Observations (n = 14 ANC 1) of interactions between patients and health workers during ANC and interviews with health workers (n = 14) were our data sources.ResultsAn intervention that included onsite training, provision of supplies and medicines, quality control and supervision was implemented in 7 health facilities in 2013. Rapid syphilis test and treatment were delivered during ANC within the examination room with no specific additional mechanism regarding staff organization. The perceived barriers were lack of training of all staff, workload, stock-outs of consumables and lack of motivation of staff. Key facilitators included political environment, ease of use of test and acceptability to pregnant women.ConclusionsOnsite testing for antenatal syphilis is a feasible and acceptable intervention in ANC at primary health facility in Burkina Faso. The point-of care test for syphilis is more likely to be acceptable by health workers as routine service and incorporated as a normal practice.Trial registrationThe study was retrospectively registered on ClinicalTrials.gov under the Trial Registration Number NCT03156751.

Barriers and facilitators to the implementation of antenatal syphilis screening and treatment for the prevention of congenital syphilis in the Democratic Republic of Congo and Zambia: results of qualitative formative research

“…Barriers for the successful implementation of same-day screening and treatment for syphilis at first ANC visit exist at system-, facility- provider- and patient-levels. Findings are similar than the reported in other studies [ 23 – 25 ]. System-level barriers include poor geographical and functional accessibility, lack of human resources and supplies, and established norms that need to be changed in order to implement the new practice, as well as the broader economic situation in these countries.…”

Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review

“…Bee et al [ 71 ] UK NPT Cognitive behavioural therapy by phone Systematic reviews [ 227 , 228 ] Feasibility study Qualitative Prospective Yes No No 38. Bocum et al [ 72 ] Burkina Faso NPM Antenatal syphilis screening Feasibility study Qualitative Retrospective Yes No Yes 39. Bouamrane and Mair [ 73 ] UK NPT Surgical assessment (online) Systematic review [ 168 ] Yes Process evaluation Qualitative Prospective Yes No N/A 40.…”

“…Here, a Norwegian team led by Wilhelmsen et al [ 145 ] showed how problems of participation and action—and especially the interactional workability—of a service providing internet-based cognitive behavioural therapy led to ambivalence on the part of general practitioners about its use, to low levels of follow-up and to doctors reverting to ‘standard treatment’ [ 145 ]. Less numerous ( n = 11, 10.1%, were studies of the implementation of screening and surveillance tools [ 38 – 42 , 53 , 64 , 65 , 72 , 77 , 113 , 129 , 132 , 139 , 144 ]). In a feasibility study, Ahmed et al [ 64 ] showed that integrating a family history questionnaire about common genetic diseases into the workflow of primary care was unlikely without significant changes to the pattern of GP-patient interactions, and these were unlikely to be supported by clinicians.…”

Management of syphilis in pregnancy: Knowledge and practices of health care providers and barriers to the control of disease in Teresina, Brazil

“…Particularly worrying is the lack of knowledge regarding the rapid syphilis test, recommended by the WHO to improve access to syphilis diagnosis. There is evidence of the cost‐effectiveness of these tests for the treatment of syphilis during pregnancy and reports of high acceptance among professionals and users . The Brazilian MoH established the implementation of RST in PNC in 2011, which may explain the lower familiarity of professionals with these tests, given its more recent deployment.…”