Protocol for Program Evaluation of the Rapid Syphilis Test Implementation Project in Southern Zambia

Project Descrption

Roughly half of syphilis-positive pregnant women will have a poor pregnancy outcome (Goldenberg, 2010). This ancient disease has a simple cure: 3 doses of injectable benzathine penicillin G (BPG). When seropositive mothers are treated with BPG at least 30 days prior to the delivery date, the risk of stillbirth or Cesarean Section drops to roughly that of a non-infected mother. However, getting treatment to women most in need remains the problem.

According to 2007 national Zambian estimates (Demographic and Health Survey 2007), 94% of pregnant women attend at least one antenatal care (ANC) visit; but, only 42% are tested for syphilis. In a national survey of syphilis seroprevalence (DHS, 2007), 40% of samples were missing in the lab.  Given that the current approach requires a minimum of 4 antenatal visits (1 for diagnosis, 3 for weekly injections) and 38% of pregnant Zambian women have 3 visits or less, there is ample room for missed diagnosis or incomplete treatment.

The standard test used in Zambian clinics is the Rapid Plasma Reagin (RPR) test. Because the RPR test is non-specific, it is prone to false positives, particularly in patients with conditions such as Epstein-Barr virus, hepatitis, varicella, measles, lymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, pregnancy, autoimmune diseases or intravenous drug abuse. A newly developed rapid syphilis test (RST) holds promise for increasing screening of pregnant women.  The RST has high sensitivity (95%), specificity (95%) and can be done within 30 minutes.  It measures antibodies specific to syphilis, therefore it will test positive for every person ever exposed.

With implementation of new a new test, the Government of Zambia needs to evaluate the impact of adding another point-of-care test to the antenatal care package. This project will evaluate the implementation of the RST in antenatal clinics. This service delivery program will train, procure and implement the point-of-care rapid syphilis test in antenatal clinics with the goal of boosting screening and treatment.

This is a sub-project of the Boston University Prevention of Mother to Child Transmission Integration Project.

Project Details

Principal Investigator Donald M. Thea
Boston University Co-Investigators Julie HerlihyGodfrey Biemba, Emily Hammond, Leoda Hamomba, Anna Knapp
Country(ies) Zambia
Dates of Activity 2006–2014