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      Point-of-Care Tests to Strengthen Health Systems and Save Newborn Lives: The Case of Syphilis

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          Abstract

          Rosanna Peeling and colleagues describe their experience of introducing point-of-care testing to screen for syphilis in pregnant women living in low- and middle-income countries.

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          Point-of-care tests for diagnosing infections in the developing world.

          R Peeling, David Mabey (2010)
          Infectious diseases continue to cause an enormous burden of death and disability in developing countries. Increasing access to appropriate treatment for infectious diseases could have a major impact on disease burden. Some common infections can be managed syndromically without the need for diagnostic tests, but this is not appropriate for many infectious diseases, in which a positive diagnostic test is needed before treatment can be given. Since many people in developing countries do not have access to laboratory services, diagnosis depends on the availability of point of care (POC) tests. Historically there has been little investment in POC tests for diseases that are common in developing countries, but that is now changing. Lack of regulation of diagnostic tests in many countries has resulted in the widespread use of sub-standard POC tests, especially for malaria, making it difficult for manufacturers of reliable POC tests to compete. In recent years increased investment, technological advances, and greater awareness about the importance of reliable diagnostic tests has resulted in rapid progress. Rapid, reliable and affordable POC tests, requiring no equipment and minimal training, are now available for HIV infection, syphilis and malaria, but POC tests for other infections are urgently needed. Many countries do not have established criteria for licensing and introducing new diagnostic tests, and many clinicians in developing countries have become disillusioned with diagnostic tests and prefer to rely on clinical judgment. Continuing advocacy and training in the use of POC tests are needed, and systems for quality control of POC tests need to be developed if they are to achieve their maximum potential.
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            Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes.

            Rebecca Balira, Helen Weiss, James Auman … (2002)
            Treatment for maternal syphilis with single-dose benzathine penicillin (2.4 million units intramuscularly) is being implemented in many parts of sub-Saharan Africa. To examine the effectiveness of this regimen, a prospective cohort of 1688 pregnant women was recruited in Tanzania. Birth outcomes were compared among women treated for high-titer (n=133; rapid plasma reagin [RPR] titer > or = 1:8 and Treponema pallidum hemagglutination assay [TPHA]/fluorescent treponemal antibody [FTA] positive) and low-titer (n=249; RPR titer <1:8 and TPHA/FTA positive) active syphilis and 950 uninfected women. Stillbirth or low-birth-weight live births were observed in 2.3% and 6.3%, respectively, of women treated for high-titer active syphilis and in 2.5% and 9.2%, respectively, of seronegative women. There was no increased risk for adverse pregnancy outcome for women treated for high-titer active syphilis (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.4-1.4) or low-titer active syphilis (OR, 0.95; 95% CI, 0.6-1.5), compared with seronegative women. Single-dose treatment is effective in preventing adverse pregnancy outcomes attributable to maternal syphilis.
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              Is antenatal syphilis screening still cost effective in sub-Saharan Africa.

              B Gumodoka, John D Watson, L Kumaranayake … (2003)
              To estimate the cost effectiveness of on-site antenatal syphilis screening and treatment in Mwanza, Tanzania. To compare this intervention with other antenatal and child health interventions, specifically the prevention of mother to child transmission of HIV (PMTCT). The economic costs of adding the intervention to routine antenatal care were assessed. Cost effectiveness (CE) ratios of the intervention were obtained for low birth weight (LBW) live births and stillbirths averted and cost per DALY saved. Cost per DALY saved was also estimated for previous CE studies of syphilis screening. The CE of the intervention at different syphilis prevalence rates was modelled. The economic cost of the intervention is $1.44 per woman screened, $20 per woman treated, and $187 per adverse birth outcome averted. The cost per DALY saved is $110 with LBW as the only adverse outcome. When including stillbirth, this estimate improves 10-fold to $10.56 per DALY saved. The cost per DALY saved from all syphilis screening studies ranged from $3.97 to $18.73. Syphilis screening is shown to be at least as cost effective as PMTCT and more cost effective than many widely implemented interventions. There is urgent need for scaling up syphilis screening and treatment in high prevalence areas. The CE of screening interventions is highly dependent on disease prevalence. In combination, PMTCT and syphilis screening and treatment interventions may achieve economies of scope and thus improved efficiency.
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                Author and article information

                Journal
                Journal ID (nlm-ta): PLoS Med
                Journal ID (iso-abbrev): PLoS Med
                Journal ID (publisher-id): PLoS
                Journal ID (pmc): plosmed
                Title: PLoS Medicine
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Print): 1549-1277
                ISSN (Electronic): 1549-1676
                Publication date Collection: June 2012
                Publication date (Print): June 2012
                Publication date (Electronic): 12 June 2012
                Volume: 9
                Issue: 6
                Electronic Location Identifier: e1001233
                Affiliations
                [1 ]London School of Hygiene and Tropical Medicine, London, United Kingdom
                [2 ]Alfredo da Matta Foundation, Manaus, Brazil
                [3 ]Elizabeth Glaser Pediatric AIDS Foundation, Kampala, Uganda
                [4 ]National Institute of Medical Research, Mwanza, Tanzania
                [5 ]The National Center for Sexually Transmitted Diseases, Center for Disease Control, Nanjing, China
                [6 ]The Universidad Peruana Cayetano Heredia, Lima, Peru
                [7 ]Elizabeth Glaser Pediatric AIDS Foundation, Lusaka, Zambia
                [8 ]Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
                [9 ]Research Policy & Cooperation (RPC/IER), World Health Organization, Geneva, Switzerland
                Author notes

                Conceived and designed the experiments: DCM ASB EB JC XSC YPY PJG SStrasser NC FTP RWP. Performed the experiments: ASB EB JC XSC YPY PJG SStrasser NC FTP. Analyzed the data: DCM KAS HAK ASB EB JC XSC YPY PJG SStrasser NC FTP SSweeney TP RWP. Wrote the first draft of the manuscript: DCM KAS RWP. Contributed to the writing of the manuscript: DCM KAS HAK ASB EB JC XSC YPY PJG SStrasser NC FTP SSweeney TP RWP. ICMJE criteria for authorship read and met: DCM KAS HAK ASB EB JC XSC YPY PJG SStrasser NC FTP SSweeney TP RWP. Agree with manuscript results and conclusions: DCM KAS HAK ASB EB JC XSC YPY PJG SStrasser NC FTP SSweeney TP RWP.

                The Health in Action section is a forum for individuals or organizations to highlight their innovative approaches to a particular health problem.

                Article
                Publisher ID: PMEDICINE-D-11-02624
                DOI: 10.1371/journal.pmed.1001233
                PMC ID: 3373627
                PubMed ID: 22719229
                SO-VID: 3e363a44-8536-4bed-bafb-af24dc9dad51
                Copyright © Mabey et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Page count
                Pages: 6
                Categories
                Subject: Health in Action
                Subject: Medicine
                Subject: Infectious Diseases
                Subject: Sexually Transmitted Diseases
                Subject: Syphilis
                Subject: Infectious Disease Control

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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