20 June 2012

Africa: Countries Rush Rapid Maternal Syphilis Tests Into Service

Rapid tests that could cut syphilis-related stillbirths and neonatal mortality have been taken up by several countries ahead of the publication of an international study on their effectiveness.

For some years, point-of-care tests (POCTs) have been available as an alternative to rapid plasma reagin (RPR) testing for syphilis. Unlike RPR, POCTs do not require specialist training or laboratory equipment, and results are available immediately, allowing swift treatment and ending the need for patients to return to the clinic to get test results.

The London School of Hygiene and Tropical Medicine ran a one-year feasibility study in Brazil, China, Peru, Tanzania, Uganda and Zambia to evaluate POCTs combined with same-day penicillin treatment, to determine whether they could be introduced effectively in countries with different health systems.

It was so successful that all six participating countries have incorporated the tests into national health guidelines before the study's publication in PLoS Medicine last week (12 June).

"Policymakers needed evidence on which test to use instead of RPR," John Changalucha, principal investigator for the project in Tanzania, told SciDev.Net.

During the study, more than 100,000 women attending antenatal clinics were screened, and more than 90 per cent of women who tested positive were treated the same day.

POCTs are now part of health policy in China, Peru, Tanzania, Uganda and Zambia, and have been introduced in Brazil for women in remote communities.

"We have shown that the rapid test can be used in different scenarios and countries, including difficult conditions in the Amazon with high humidity and high temperatures," Adele Benzaken, a principal investigator for the project in Brazil, told SciDev.Net.

The study's authors say the method's success is also due to close collaboration between health partners and national policymakers, a commitment to incorporate the test into existing health systems, and the provision of quality assurance to ensure that tests results are accurate.

"The main challenge was ensuring the constant supply of rapid tests and drugs," Changalucha said, adding that he believes POCTs could eventually replace RPR testing altogether.

Brazil is producing the test kits and drugs itself to ensure a reliable, affordable supply, Benzaken said.

In March this year, a consortium of international health agencies launched the Global Congenital Syphilis Partnership (GCSP) to build on the feasibility study's success and roll the rapid test out in more countries.

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