Informing Policy and Program Decisions for Scaling up Syphilis and HIV Testing in Bolivia through a Joint Technical Mission

Background: In Bolivia, prevalence of maternal syphilis has been estimated to range from 3-7% in various settings. In 2009, PAHO/UNICEF launched the Regional Initiative for Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis. Achieving the outcome targets of the initiative requires increased testing of all pregnant women for both syphilis/HIV in ANC facilities.  We conducted a Joint Technical Mission to identify strategies and formulate recommendations to expand access to syphilis/HIV testing in Bolivia

Methods: A national steering committee, led by the Bolivian Ministry of Health and composed of in-country and international partners, was established. Desk reviews (reports, program indicators, policies), orientation meetings, site visits to health facilities, thematic discussions of priority areas, and final de-briefing of national policy makers and in-country partners were undertaken. Health facility visits included assessment of syphilis/HIV testing algorithms and laboratory quality assurance procedures at 5 clinical sites and 4 reference laboratories in La Paz, Cochabamba, and Santa Cruz.  Strengths and challenges were identified in provision of syphilis/HIV testing and treatment services. A national consensus meeting was convened.  

Results: Two syphilis testing algorithms were approved by consensus, one for laboratory use and one for point-of-care use, which will facilitate same-day testing and treatment. A simplified HIV testing algorithm using rapid tests was also approved by consensus. A set of joint recommendations for policy and programmatic action were agreed upon that included: a procurement and training strategy; piloting and scale-up of approved algorithms; implementing policies to assure testing/treatment of partners; strengthening of monitoring systems; and scale-up of quality-control programs. 

Conclusions: A Joint Technical Mission created a platform for common action, and contributed to national scale-up of syphilis/HIV testing through coordination of mechanisms for programs and support for development of national scale-up plans. Continued support and targeted technical assistance are essential to achieve outcome targets of the PAHO/UNICEF initiative.