Background: Prenatal screening to prevent congenital syphilis and perinatal HIV is challenging in municipalities with low laboratory capacity. A screening program utilizing filter paper processed by a centralized state lab was implemented in the 92 municipalities of Rio de Janeiro state beginning in 2010.
Methods: Interviews were conducted with a sample of program coordinators in 7 municipalities of Rio de Janeiro to gauge program acceptance and advantages/disadvantages of filter paper screening in municipalities with varying socio-economic-environmental profiles. All interviews were recorded and transcribed. Transcriptions were analyzed and cross-referenced with secondary data obtained from the Ministry of Health and the Brazilian Institute of Geography and Statistics.
Results: The filter paper screening was most accepted and viewed as most useful in municipalities where traditional laboratory testing was problematic due to local laboratory inefficiency, shortages and in at least one case natural disasters that led to laboratory closing. Some municipalities reported filter paper screening as a facilitator in partner testing and treatment. Increased notification resulting in improved patient follow-up was identified as an advantage of the program, especially in municipalities with lower institutional capacity where underreporting is common. Higher cost of filter paper and delayed results were identified as disadvantages in municipalities with higher laboratory capacity.
Conclusions: Screening with filter paper processed by a centralized lab is advantageous for municipalities with low laboratory capacity, reducing wait times for testing and results, and improving reporting and follow-up to prevent vertical transmission of HIV and syphilis. Municipalities may require different screening processes depending on their institutional capacity.