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Background: The World Health Organization recommends at least 95% of pregnant women receive syphilis testing at their first antenatal care visit, as untreated infections can lead to severely adverse pregnancy outcomes. In Malawi, pregnant women routinely receive HIV testing, but only 10% are tested for syphilis. We assessed potential barriers to national scale-up of a novel dual-platform rapid diagnostic test (RDT) integrating syphilis with HIV testing on one device.
Methods: During June–July 2015, we conducted semi-structured interviews with 25 healthcare providers, laboratorians, Ministry of Health leaders, and agency representatives working in prevention of mother-to-child transmission in Malawi. Participants were asked about the importance of the RDT, concerns using and procuring the RDT, and recommendations for national expansion. Data were analyzed using NVivo 10.
Results: Participants viewed the test favorably, citing the importance of dual RDTs for preventing missed opportunities for syphilis diagnosis and treatment, improving infant outcomes, and increasing syphilis testing coverage. Participants believed the dual RDT may prevent syphilis test stock-outs resulting from the national prioritization of HIV test procurement. Primary technical concerns were about the additional procedural steps needed to perform the test, the possibility that testers may not adhere to required waiting times before interpreting results, and difficulty reading and interpreting test results lines. Most strongly believed pregnant women would be unwilling to pay for a dual RDT and Ministry funding would be necessary. Participants thought national scale-up would require demonstration of cost-savings, training of testers, clarity on populations to be tested, revisions to testing guidelines and algorithms, and a reliable supply chain.
Conclusions: Stakeholders largely support implementation of an HIV/syphilis RDT as a feasible alternative to current antenatal testing. Scale-up will require addressing perceived barriers; negotiating changes to existing algorithms and guidelines; and Ministry of Health approval and funding to support training of staff and procurement of supplies.