Low and stable rates of antenatal syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study

Abstract

Objective: The antenatal prevalence of syphilis and HIV/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in the same population and reassess the trends in HIV rates.Methods: From August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border.Results: Seroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13/2,123). The three active (VDRL≥1:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (>75% were < 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors.Conclusion: As HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies.

Mediation of the effect of malaria in pregnancy on stillbirth and neonatal death in an area of low transmission: observational data analysis

“…Many of our confidence intervals were also wide due to the rarity of stillbirth and neonatal death. The rate of stillbirth is low relative to those of other resource-limited settings, despite efforts to ascertain birth outcomes in all women (including those who delivered at home), and may be due in part to the low incidence of syphilis, the high number of ANC consultations, and the high proportion of deliveries attended by a skilled birth attendant at SMRU clinics [16, 24, 25]. The proportion of women lost to follow-up was not negligible, and we assumed non-informative right censoring (whereby the loss to follow-up is not due to experiencing the outcome) (see Additional file 10).…”

“…In the refugee camps where the denominator is known, 90% of pregnant women in the population attend SMRU ANCs. Syphilis and HIV were not routinely tested for, but prevalence is very low [16]. The Oxford Tropical Research Ethics Committee granted ethical approval for audits of SMRU clinical records (OXTREC 28-09), and the Tak Community Advisory Board granted local approval (TCAB-4/1/2015).…”

Prevalences of inherited red blood cell disorders in pregnant women of different ethnicities living along the Thailand-Myanmar border

“…Due to fragmented education affected by conflict, poverty and migration, approximately 50% of ANC attendants are illiterate ( Carrara et al , 2011 ), and the majority are totally unfamiliar with concepts of genetics and inheritance. The challenge of counselling about often asymptomatic diseases with complex implications is significant ( McGready et al , 2014 ) and could result in dire unintended consequences in some individuals. In countries where haemoglobinopathies are common, several screening approaches have been developed (for a review see Amato et al , 2014 ).…”

First-trimester artemisinin derivatives and quinine treatments and the risk of adverse pregnancy outcomes in Africa and Asia: A meta-analysis of observational studies

“…Multivariate analyses adjusted for infection severity (asymptomatic, symptomatic, hyperparasitemic/severe), year of first consultation, and non-malaria febrile morbidity in first trimester. HIV was not accounted for, but the prevalence on the Thailand–Myanmar border is very low [34]. Count data on major congenital anomalies by organ system were used to derive pooled prevalence estimates for exposure groups.…”