Impact of the dual rapid diagnostic test for HIV and syphilis among pregnant women: a before and after health center-based study in Central Uganda (2018-2019).

OBJECTIVES: Systematic testing of antenatal clinic attendees using dual HIV and syphilis rapid diagnostic tests (RDT) can improve syphilis screening and reduce mother-to-child transmission. We assessed the effect of the dual HIV/syphilis RDT on syphilis care and adverse birth outcomes (ABOs), including congenital syphilis (CS) in Central Uganda. METHODS: Eleven antenatal clinics were selected from Kalungu and Masaka districts. First-visit records were extracted on syphilis testing, positivity and treatment over two 9-month periods, pre- and post-introduction, with a 3-month buffer. Syphilis cascade indicators were calculated for the two periods. The World Health Organization CS Estimation Tool evaluated impact on CS cases and ABOs. RESULTS: A total of 6011 records were extracted, 2660 pre-test introduction and 3351 post-introduction. Syphilis testing increased from 49.1% pre-test to 84.0% post-introduction, an increased testing rate ratio of 1.71 (95% confidence interval 1.64-1.78). Treatment coverage modestly increased post-introduction (rate ratio = 1.19, 0.94-1.50), resulting in an absolute rate difference of 31.4% (20.5-41.6%, P <0.001). This resulted in a modeled 41% decline in CS cases and 39% decline in ABOs. CONCLUSIONS: This is the first demonstration of the impact of dual HIV/syphilis RDT in routine antenatal clinics in Uganda, which could reduce CS and ABOs.