Syphilis screening in Mozambique

Montoya, Pablo; Lukehart, Sheila A.; Brentlinger, Paula E.; Blanco, Ana Judith; Floriano, Florência; Sairosse, Josefa; Gloyd, Stephen

doi:10.2471/blt.04.018663

Cited by 63 publications

(10 citation statements)

References 31 publications

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“…Determine was the only test showing a statistically significant lower specificity among HIV positive specimens. This phenomenon has been described elsewhere [29] , [35] and may be the result of immune activation and subsequent deranged B-cell function in HIV [36] which presumably can lead to false positive tests. This is clearly important in settings such as Europe, USA and Australia where among gay men, up to 60% the syphilis infections are in HIV-positive individuals [37] – [39] , such that approximately 1 in 6 reactive tests could be a false positive in this population.…”

Section: Discussionmentioning

confidence: 74%

A Laboratory-Based Evaluation of Four Rapid Point-of-Care Tests for Syphilis

et al. 2014

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BackgroundSyphilis point-of-care tests may reduce morbidity and ongoing transmission by increasing the proportion of people rapidly treated. Syphilis stage and co-infection with HIV may influence test performance. We evaluated four commercially available syphilis point-of-care devices in a head-to-head comparison using sera from laboratories in Australia.MethodsPoint-of-care tests were evaluated using sera stored at Sydney and Melbourne laboratories. Sensitivity and specificity were calculated by standard methods, comparing point-of-care results to treponemal immunoassay (IA) reference test results. Additional analyses by clinical syphilis stage, HIV status, and non-treponemal antibody titre were performed. Non-overlapping 95% confidence intervals (CI) were considered statistically significant differences in estimates.ResultsIn total 1203 specimens were tested (736 IA-reactive, 467 IA-nonreactive). Point-of-care test sensitivities were: Determine 97.3%(95%CI:95.8–98.3), Onsite 92.5%(90.3–94.3), DPP 89.8%(87.3–91.9) and Bioline 87.8%(85.1–90.0). Specificities were: Determine 96.4%(94.1–97.8), Onsite 92.5%(90.3–94.3), DPP 98.3%(96.5–99.2), and Bioline 98.5%(96.8–99.3). Sensitivity of the Determine test was 100% for primary and 100% for secondary syphilis. The three other tests had reduced sensitivity among primary (80.4–90.2%) compared to secondary syphilis (94.3–98.6%). No significant differences in sensitivity were observed by HIV status. Test sensitivities were significantly higher among high-RPR titre (RPR≥8) (range: 94.6–99.5%) than RPR non-reactive infections (range: 76.3–92.9%).ConclusionsThe Determine test had the highest sensitivity overall. All tests were most sensitive among high-RPR titre infections. Point-of-care tests have a role in syphilis control programs however in developed countries with established laboratory infrastructures, the lower sensitivities of some tests observed in primary syphilis suggest these would need to be supplemented with additional tests among populations where syphilis incidence is high to avoid missing early syphilis cases.

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Section: Discussionmentioning

confidence: 74%

A Laboratory-Based Evaluation of Four Rapid Point-of-Care Tests for Syphilis

et al. 2014

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“…Outlining the importance of good training, a study conducted in Mozambique demonstrated greater accuracy of POCTs when conducted by laboratory staff with intensive training, rather than when conducted by health care workers on bedside. Further, Balira et al [ 50 ] documented that only 25% of ANC staff in Tanzania received training in the prevention of syphilis mother-to-child transmission, in general [ 51 ]. Additionally, as countries begin to introduce syphilis POCTs, adequate quality assurance programmes must be established, which have been the norm for most laboratory syphilis screening programs but have frequently been neglected for POCTs [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of antenatal syphilis point of care testing on pregnancy outcomes: A systematic review

Brandenburger

Ambrosino

2021

PLoS ONE

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Background Mother-to-child transmission of syphilis remains a leading cause of neonatal death and stillbirth, disproportionally affecting women in low-resource settings where syphilis prevalence rates are high and testing rates low. Recently developed syphilis point-of-care tests (POCTs) are promising alternatives to conventional laboratory screening in low-resource settings as they do not require a laboratory setting, intensive technical training and yield results in 10–15 minutes thereby enabling both diagnosis and treatment in a single visit. Aim of this review was to provide clarity on the benefits of different POCTs and assess whether the implementation of syphilis POCTs is associated with decreased numbers of syphilis-related adverse pregnancy outcomes. Methods Following the PRISMA guidelines, three electronic databases (PubMed, Medline (Ovid), Cochrane) were systematically searched for intervention studies and cost-effectiveness analyses investigating the association between antenatal syphilis POCT and pregnancy outcomes such as congenital syphilis, low birth weight, prematurity, miscarriage, stillbirth as well as perinatal, fetal or infant death. Results Nine out of 278 initially identified articles were included, consisting of two clinical studies and seven modelling studies. Studies compared the effect on pregnancy outcomes of treponemal POCT, non-treponemal POCT and dual POCT to laboratory screening and no screening program. Based on the clinical studies, significantly higher testing and treatment rates, as well as a significant reduction (93%) in adverse pregnancy outcomes was reported for treponemal POCT compared to laboratory screening. Compared to no screening and laboratory screening, modelling studies assumed higher treatment rates for POCT and predicted the most prevented adverse pregnancy outcomes for treponemal POCT, followed by a dual treponemal and non-treponemal POCT strategy. Conclusion Implementation of treponemal POCT in low-resource settings increases syphilis testing and treatment rates and prevents the most syphilis-related adverse pregnancy outcomes compared to no screening, laboratory screening, non-treponemal POCT and dual POCT. Regarding the benefits of dual POCT, more research is needed. Overall, this review provides evidence on the contribution of treponemal POCT to healthier pregnancies and contributes greater clarity on the impact of diverse diagnostic methods available for the detection of syphilis.

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“…Previous studies have noted both this difficulty and the difficulty manipulating blood transfer devices. 14 , 20 – 23 …”

Section: Discussionmentioning

confidence: 99%

Community Health Workers Use Malaria Rapid Diagnostic Tests (RDTs) Safely and Accurately: Results of a Longitudinal Study in Zambia

Counihan¹,

Harvey²,

Sekeseke-Chinyama³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

126

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Malaria rapid diagnostic tests (RDTs) could radically improve febrile illness management in remote and low-resource populations. However, reliance upon community health workers (CHWs) remains controversial because of concerns about blood safety and appropriate use of artemisinin combination therapy. This study assessed CHW ability to use RDTs safely and accurately up to 12 months post-training. We trained 65 Zambian CHWs, and then provided RDTs, job-aids, and other necessary supplies for village use. Observers assessed CHW performance at 3, 6, and 12 months post-training. Critical steps performed correctly increased from 87.5% at 3 months to 100% subsequently. However, a few CHWs incorrectly read faint positive or invalid results as negative. Although most indicators improved or remained stable over time, interpretation of faint positives fell to 76.7% correct at 12 months. We conclude that appropriately trained and supervised CHWs can use RDTs safely and accurately in community practice for up to 12 months post-training.

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Syphilis screening in Mozambique

Cited by 63 publications

References 31 publications

A Laboratory-Based Evaluation of Four Rapid Point-of-Care Tests for Syphilis

A Laboratory-Based Evaluation of Four Rapid Point-of-Care Tests for Syphilis

The impact of antenatal syphilis point of care testing on pregnancy outcomes: A systematic review

Community Health Workers Use Malaria Rapid Diagnostic Tests (RDTs) Safely and Accurately: Results of a Longitudinal Study in Zambia

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