Syphilis control during pregnancy: effectiveness and sustainability of a decentralized program

Abstract

OBJECTIVES: This study sought to assess the performance, effectiveness, and costs of a decentralized antenatal syphilis screening program in Nairobi, Kenya. METHODS: Health clinic data, quality control data, and costs were analyzed. RESULTS: The rapid plasma reagin (RPR) seroprevalence was 3.4%. In terms of screening, treatment, and partner notification, the program's performance was adequate. The program's effectiveness was problematic because of false-negative and false-positive RPR results. The cost per averted case was calculated to be US$95 to US$112. CONCLUSIONS: The sustainability of this labor-intensive program is threatened by costs and logistic constraints. Alternative strategies, such as the mass epidemiologic treatment of pregnant women in high-prevalence areas, should be considered.

Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysis

“…Our base case results are largely in line with previous studies on the cost-effectiveness of antenatal syphilis screening using the plasma reagin test in resource-limited settings, which estimated a cost per DALY averted of US$4 in Zambia [30] (versus US$3 in our model; 95% CI: US$2–US$7), US$10 in Kenya [31],[32] (versus US$9 in our model; 95% CI: US$4–US$35), and US$11 in Tanzania [33] (versus US$8 in our model; 95% CI: US$4–US$28). All of these previously published estimates fall within the bounds of our 95% confidence intervals.…”

Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework

“…Continued dialogue with community members [ 41 ] 7. Building on pre-existing capacity of community-based organizations to organize themselves [ 57 ] Lack of financial leadership 1. Lack of remuneration for caregivers [ 70 ] 2.…”

“…Inability to guarantee continuity of future resources [ 72 ] 12. Lack of communication about funding termination [ 57 ] 13. Lack of medical equipment and uncertainty about securing future funds for equipment [ 32 ] Community buy-in through volunteerism 1.…”

“…Lack of staff [ 55 ] Sound infrastructure 1. Community leadership support and administrative structures to foster supportive environment, efficiency, and commitment [ 33 , 40 , 45 , 17 , 57 , 74 , 76 ] 2. Resource contribution; resources to support innovations [ 33 , 45 , 46 , 75 , 51 ] 3.…”

“…(a) Enforcing use of standard guidelines; (b) staff training, mentorship, and technical support; (c) strengthening ministry’s supply and logistics for procuring and maintaining services; (d) quality assurance/quality improvement system provided basis for continuous assessment and monitoring of services [ 49 ] 15. (a) Social cash transfer scheme at national level; (b) coordination between health resources at district and community levels [ 57 ] 16. Capacity building through skill building [ 32 ] 17.…”