Old disease, new technology: Winning the syphilis battle with mHealth and community based agents

Rationale: An estimated 50% of maternal syphilis infections result in stillbirth or congenital infection. Affordable rapid testing and effective treatment exist; the challenge lies in boosting screening and ensuring treatment for hard-to-reach mothers. Measuring the success of service delivery models is challenging; a low-cost test is needed to accurately measure the rate of newborn transmission in addition to the current method of counting stillbirths, a poor surrogate of congenital syphilis (CS) infection.

Approach: A prospective cohort study of pregnant women in Southern Province, Zambia comparing standard of care to a two-prong strategy that will: 1) increase testing via deployment of a rapid syphilis test; 2) boost treatment adherence by pairing pregnant women with community-based agents prompted by mHealth/SMS treatment reminders. We will follow 4,256 women (2,128 intervention-exposed). In addition to recording stillbirths, we propose a hard biological outcome measure: a novel immunological test specific for CS at 6 weeks of age performed on a dried blood spot sample.

Objectives: To decrease syphilis-related stillbirths and CS by half through improved screening and treatment using rapid diagnostics, mHealth and community-based agents. We propose to adapt and test a low-cost immunological test to detect CS at 6 weeks old providing a new outcome measure.

Innovation: 1) deployment of a rapid diagnostic syphilis test; 2) pre-programmed patient-specific SMS treatment reminders to community-based agents to facilitate treatment; 3) novel low-cost outcome measure to detect CS at 6 weeks old.