Introduction of rapid syphilis testing in antenatal care: A systematic review of the impact on HIV and syphilis testing uptake and coverage

Abstract

Background: Global guidelines recommend universal syphilis and HIV screening for pregnant women. Rapid syphilis testing (RST) may contribute toward achievement of universal screening.

Objectives: To examine the impact of RST on syphilis and HIV screening among pregnant women.

Search strategy: We searched MEDLINE for English- and non-English language articles published through November, 2014.

Selection criteria: We included studies that used a comparative design and reported on syphilis and HIV test uptake among pregnant women in low- and middle-income countries (LMICs) following introduction of RST.

Data collection and analysis: Data were extracted from six eligible articles presenting findings from Asia, Africa, and Latin America.

Main results: All studies reported substantial increases in antenatal syphilis testing following introduction of RST; the latter did not appear to adversely impact antenatal HIV screening levels at sites already offering rapid HIV testing and may increase HIV screening among pregnant women in some settings. Qualitative data revealed that women were highly satisfied with RST. Nevertheless, ensuring adequate training for healthcare workers and supplies of commodities were cited as key implementation barriers.

Conclusions: RST may increase antenatal syphilis and HIV screening and contribute to the improvement of antenatal care in LMICs.

Keywords: HIV; Point-of-care test; Pregnancy; Screening; Syphilis.

Fig. 1.

Flow diagram of study selection. Abbreviations: LMIC, low- and middle-income country; RST, rapid syphilis testing.

Fig. 2.

Proportion of pregnant women screened for syphilis and HIV prior to and following the introduction of rapid syphilis testing. Note: Excludes data from China (data on syphilis screening prior to introduction of rapid syphilis testing (RST) not available) and India (findings not disaggregated by test type). ^a Proportion of pregnant women screened who received their results in less than 45 minutes. ^b Proportion of first-time antenatal care attendees screened. ^c HIV results are for health facilities that did not experience stockouts of HIV test kits. ^d Proportion of pregnant women screened. No data on HIV presented. ^e Proportion of expected number of pregnant women screened. Zero women were screened for syphilis prior to introduction of RST.