Integration of antenatal syphilis screening in an urban HIV clinic

A feasibility study

Yukari C Manabe, Gertrude Namale, Elizabeth Nalintya, Joseph Sempa, Rosalind Parkes Ratanshi, Nadine Pakker, Elly Katabira

Research output: Contribution to journalArticle

Abstract

Background: Syphilis infection during pregnancy leads to avoidable morbidity and mortality and remains a significant problem in sub-Saharan Africa. Despite global initiatives to increase the proportion of pregnant women screened, implementation has been slow. We sought to investigate the feasibility of adding syphilis screening within an integrated antenatal HIV clinic. Methods: Pregnant women attending the HIV antenatal clinic were sequentially enrolled and consenting participants answered a questionnaire on sexual behavior and previous pregnancies, provided sociodemographic data, and were tested using rapid plasmin reagin (RPR). If positive, participants were treated with benzathine penicillin. All were given a partner notification slip and were followed up after delivery to determine birth outcomes. Results: 584 of 606 (95.7%) women approached and consented to test for syphilis. 570 women were enrolled (median age 29 (IQR 25-32) with a median (IQR) CD4 of 372 (257-569) cells/μL). Of the 5.1% (29/570) with a positive RPR, all were asymptomatic, were successfully contacted, and treated with benzathine penicillin without adverse reactions. Overall, 61 (12.1%) of the participants had an adverse birth outcome. In the bivariate analysis, only age was significantly different between those with and without a positive RPR (RR = 1.15, 95% CI 1.065-1.248; p <0.001). Partners of only 10 (34.5%) participants returned for treatment. Conclusions: Structural interventions such as opt-out testing for syphilis within integrated HIV-antenatal care clinics are feasible and capitalize on the excellent care programs that have already been established for HIV care. Novel approaches are required for partner notification.

Original languageEnglish (US)
Article number739
JournalBMC Infectious Diseases
Volume15
Issue number1
DOIs
StatePublished - Jan 13 2015

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Reagins
Feasibility Studies
Syphilis
Prenatal Diagnosis
Fibrinolysin
HIV
Penicillin G Benzathine
Contact Tracing
Pregnant Women
Parturition
Pregnancy
Prenatal Care
Africa South of the Sahara
Sexual Behavior
Morbidity
Mortality
Infection
Therapeutics

Keywords

  • Antenatal
  • HIV
  • Integration
  • Partner testing
  • Syphilis

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Integration of antenatal syphilis screening in an urban HIV clinic : A feasibility study. / Manabe, Yukari C; Namale, Gertrude; Nalintya, Elizabeth; Sempa, Joseph; Ratanshi, Rosalind Parkes; Pakker, Nadine; Katabira, Elly.

In: BMC Infectious Diseases, Vol. 15, No. 1, 739, 13.01.2015.

Research output: Contribution to journalArticle

Manabe, Yukari C ; Namale, Gertrude ; Nalintya, Elizabeth ; Sempa, Joseph ; Ratanshi, Rosalind Parkes ; Pakker, Nadine ; Katabira, Elly. / Integration of antenatal syphilis screening in an urban HIV clinic : A feasibility study. In: BMC Infectious Diseases. 2015 ; Vol. 15, No. 1.
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abstract = "Background: Syphilis infection during pregnancy leads to avoidable morbidity and mortality and remains a significant problem in sub-Saharan Africa. Despite global initiatives to increase the proportion of pregnant women screened, implementation has been slow. We sought to investigate the feasibility of adding syphilis screening within an integrated antenatal HIV clinic. Methods: Pregnant women attending the HIV antenatal clinic were sequentially enrolled and consenting participants answered a questionnaire on sexual behavior and previous pregnancies, provided sociodemographic data, and were tested using rapid plasmin reagin (RPR). If positive, participants were treated with benzathine penicillin. All were given a partner notification slip and were followed up after delivery to determine birth outcomes. Results: 584 of 606 (95.7{\%}) women approached and consented to test for syphilis. 570 women were enrolled (median age 29 (IQR 25-32) with a median (IQR) CD4 of 372 (257-569) cells/μL). Of the 5.1{\%} (29/570) with a positive RPR, all were asymptomatic, were successfully contacted, and treated with benzathine penicillin without adverse reactions. Overall, 61 (12.1{\%}) of the participants had an adverse birth outcome. In the bivariate analysis, only age was significantly different between those with and without a positive RPR (RR = 1.15, 95{\%} CI 1.065-1.248; p <0.001). Partners of only 10 (34.5{\%}) participants returned for treatment. Conclusions: Structural interventions such as opt-out testing for syphilis within integrated HIV-antenatal care clinics are feasible and capitalize on the excellent care programs that have already been established for HIV care. Novel approaches are required for partner notification.",
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