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Integration of Preventing Mother-To-Child Transmission of HIV and Syphilis Testing and Treatment in Antenatal Care Services in the Northern Cape and Gauteng Provinces, South Africa

and∥Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Sexually transmitted diseases (Impact Factor: 2.84). 11/2013; 40(11):846-851. DOI: 10.1097/OLQ.0000000000000042
Source: PubMed

ABSTRACT

South Africa recommends universal syphilis and HIV testing in pregnancy, with prompt antiretroviral therapy or penicillin treatment for women testing positive.
We used a multistage, purposeful sampling strategy to retrospectively identify clinical records from a sample (7.3%) of 32,518 women delivering from January 2005 to June 2006 at 6 public clinics in the Northern Cape and Gauteng. Descriptive analyses and logistic regression were used to assess coverage and factors related to testing and treatment of HIV and syphilis.
Of 2379 women sampled, 93% accessed antenatal care (ANC) services during pregnancy and 71% before the third pregnancy trimester. Testing during pregnancy or delivery was 74% for HIV and 84% for syphilis; testing at the first ANC visit was 41% and 71%; and infection prevalence at delivery was 14% and 5%, respectively. Of 243 women with reactive HIV tests, 104 (43%) had treatment documented (single-dose nevirapine) before delivery. Of 98 women with reactive syphilis tests, 73% had documented receipt of 1 penicillin injection and 36% had all 3 recommended injections. Multivariable analysis found women tested for syphilis were almost 4 times more likely to have had no HIV test compared with those without syphilis testing (adjusted odds ratios, 3.9; 95% confidence interval, 1.7-5.5).
Integration and provision of a package of HIV and syphilis testing at the first ANC visit and decentralizing treatments of both infections to primary care settings could increase the coverage of testing and treatment services, thus enhancing the effectiveness of current programs eliminating mother-to-child transmission of HIV and syphilis.

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Available from: Thu-Ha Dinh, Oct 15, 2015
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    • "However, studies on integrated care have primarily examined single aspects such as the acceptability of offering several tests during the same visit [13] or of dual testing [14]. Such studies evaluate the feasibility of integration at the point of service delivery but not the effectiveness of integrated services within a health system [15]. Herein, the implementation bottlenecks for effective coverage of syphilis, HIV, and anemia screening in rural Tanzania and Uganda are identified and compared utilizing a novel approach linking data from households and health facilities to estimate population coverage in stages of implementation and key informant interviews to explore underlying determinants and potential solutions to the identified bottlenecks. "
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    • "Practical strategies to increase the rate of syphilis screening in antenatal care may involve integrating rapid syphilis testing into existing HIV screening services. Recent evidence indicates that such an integrated approach was feasible in resource-limited settings and resulted in increased screening rates in South Africa[18], as well as Uganda and Zambia[19], and was found to be highly cost-effective in China[20]. Eventually, it could be expanded further to also include screening for Hepatitis B in a triple point-of-care test[21]. "

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