P3.357 Integration of Rapid Syphilis Testing into Routine Antenatal Services in Rural Kenya: Successes and Challenges

Abstract

Objective Evaluate introduction of rapid syphilis tests (RSTs) into antenatal clinic (ANC) services at low-level health facilities in 2 rural districts in Nyanza Province, Kenya - assessing coverage, testing quality, treatment, data recording, and effect on HIV testing. Method(s): From March 2011 - February 2012, RSTs were introduced into ANC services at 25 rural facilities. Before introduction, hands-on training was conducted for nurses on use of RSTs, results counselling, appropriate maternal treatment, documenting data and proficiency testing. During the programme, 3 proficiency testing rounds were done. After the programme, ANC log-books from 8 priority clinics were used to assess data reporting and compare coverage of syphilis and HIV testing and syphilis treatment for the 12-month intervals before and during the programme. Nurses and mothers were also interviewed. Result(s): Thirty-four nurses from 25 clinics were trained. Proficiency testing identified and corrected early RST problems. In the 8 priority clinics, syphilis testing at first ANC visit increased from 18% (279/1586 attendees) in the 12 months before to 70% (1123/1614 attendees) during the 12-month programme (p < 0.001); 35 women (3%) tested positive during the programme vs. 1 (< 1%) in the previous 12 months (p < 0.001). RST use and results were routinely documented, but no clinic recorded treatment per training. In 5 clinics, assessment of HIV test coverage was limited by lack of prior HIV-positivity data; however, records from 3 high-volume clinics suggested no difference in HIV testing rates before and during the programme. Interviews indicated many new nurses were not trained, while mothers reported limited counselling about testing or results. Conclusion(s): Introducing RSTs into rural ANC services greatly increased syphilis testing and detection without effects on HIV testing. We identified challenges in documenting treatment, counselling women appropriately, and adequate training. Amendments to existing and "refresher" training may improve services and documentation of treatment.