S4.5 Maternal syphilis testing and treatment to improve maternal and child health services: progress and challenges

Abstract

Background: In 2007, WHO released the document Global Elimination of Congenital Syphilis, Rationale and Strategy for Action, developed in collaboration with a team of expert consultants. The strategy aims to prevent mother to child transmission of syphilis through the strengthening of antenatal care programs to ensure: Early antenatal care for all women, with universal syphilis screening and prompt treatment of those infected Treatment of all sexual partners of infected women, promotion of condom use during pregnancy, and counselling of all women on how to prevent infection All neonates born to RPR-positive mothers are given a single dose of penicillin as prophylactic treatment. This presentation documents progress in the global elimination initiative thus far, notes challenges towards substantial reduction in congenital syphilis by 2015, and proposes areas for focus in the next 2 years. Methods/results Most progress has been made in areas of advocacy and recognition of the public health problem, the emergence of rapid diagnostic tests and (in some areas of the world) integrated intervention initiatives such as those linking prevention of mother to child transmission of HIV and congenital syphilis. Progress has also been made in integration of a handful of critical indicators into existing data collection systems, allowing better monitoring of national and global program progress. Publication of program evaluations has been mixed, with increased reporting on evaluations of implementing testing and treatment strategies, but still limited research on validation of proposed impact targets (eg, use of stillbirth as an indicator of impact). Additionally, specific funding remains limited, although an Investment Case for donors is near completion and some new opportunities for funding integrated services have arisen. Conclusions: Some emerging global issues such recent initiatives and trends in global public health financing may influence future progress. National guidelines on testing strategies are needed to avoid less than optimal or more costly than needed testing strategies. More focused efforts on earlier and higher quality antenatal care will likely support congenital syphilis elimination along with promoting better overall antenatal services.