The utility of a rapid point-of-care test for syphilis in an art clinic in Tigoni

Abstract

Problem Statement: The Sub-Saharan African region has a high prevalence of both HIV infection and syphilis. Access to diagnosis is poor or non-existent in this region. Syphilis can mimic HIV infection and vice versa. HIV can lead to more numerous chancres, accelerated secondary syphilis, and faster progression to late syphilis. Management of Syphilis is important for control and prevention of HIV infection and transmission. Background: Sexually transmitted infections (STIs) are a major global cause of acute illness, infertility, long term disability and death, with severe medical and psychological consequences for millions of men, women and infants. World Health Organization global estimates indicate that there are about 387 million new cases of curable sexually transmitted infections every year, 80-90% of which are in resource-poor countries where there is poor or no access to diagnosis. Most of these infections occur in men and women aged 15-49 years. WHO further estimates that approximately 12 million new cases or syphilis occur worldwide each year. In developing countries, STIs and their complications are amongst the top five disease categories for which adults seek health care. In women of childbearing age, STIs (excluding HIV) are second only to maternal factors as causes of disease, death and healthy life lost. Apart from being serious diseases in their own right, STIs enhance the sexual transmission of HIV infection. The presence of an untreated STD (ulcerative or non-ulcerative) can increase the risk of both acquisition and transmission of HIV by a factor of up to 10. Moreover, the improvement in the management of STIs can reduce the incidence of HIV-l infection in the general population by about 40%. STIs prevention and treatment are, therefore, an important component in HIV prevention strategy. Main Objective To determine the operational feasibility and diagnostic utility of a rapid point-of-care syphilis test in an ART clinic in Tigoni, Kenya •• Specific Objectives: I. To determine the feasibility and utility of a rapid point-of-care syphilis test in an ART clinic 2. To establish the prevalence of syphilis in adults attending an ART clinic in Tigoni District Hospital 3. To compare the clinical stage of HIV and Syphilis seropositivity Methods & Materials: The study was conducted in a busy ART clinic in Tigoni District Hospital, Tigoni, Kiambu District in Kenya. All eligible consenting patients were screened for syphilis using a rapid test. Those whose test were positive were counseled, and given a prescription for treatment before they left. Their blood was also taken for a confirmatory test whose results they would be told at the next visit. Study Design: This was a descriptive cross-sectional survey. Sample Size and sampling method About 400 patients were enrolled in the ART clinic in Tigoni Hospital at the time of commencement of the study. The prevalence of syphilis in antenatal clinic in a previous study in Nairobi was 6%. A calculated sample size of 229 was required. A stratified random sampling method was used in order to have about 25% of the sample being men since majority of attendees of this clinic are women. Results: The clinical presentation of syphilis in HIV is often blurred. The introduction of a rapid cost-effective POC test for syphilis in a busy ART clinic was feasible and enabled treatment of syphilis to be started on the same clinic day. This meant that hitherto undetected co-infection with syphilis of HlV patients was better managed and the longterm goal of improvement of control and reduction of transmission of HlV was possible. The prevalence of syphilis in a HlV positive adult cohort was 5.5%, somewhat lower than expected in a HlV positive cohort, as well as lower than the WHO estimated seroprevalence of syphilis for Sub-Saharan Africa. The numbers were too small however, for a conclusive comparison of clinical stage of HlV and syphilis .