Accelerating introduction of dual syphilis/HIV rapid diagnostic tests

Elimination of mother-to-child transmission of syphilis and HIV directly contributes towards attaining Millennium Development Goals 4 (neonatal health), 5 (maternal health), and 6 (HIV prevention). However, in 2010, only 68% of pregnant women in low-and middle-income countries were tested for syphilis, and only 35% were tested for HIV. As a result, syphilis contributed to 440,000 stillbirths and neonatal deaths in 2008, and 390,000 children were newly infected with HIV in 2010.

Innovative strategies are needed to ensure all pregnant women are tested for syphilis and HIV early in pregnancy. We will assess performance of three newly available dual rapid diagnostic tests (RDTs) in laboratory evaluation, and field test the two highest performing RDTs in conjunction with a web-linked hand-held optical reader offering patient-tailored care algorithms.

The field test will assess not only test performance, but also acceptability of dual testing by patients and staff, impact of optical reader on test quality, acceptability of web-based surveillance to improve program and procurement, utility of patient-tailored care algorithms, and impact on testing and treatment uptake.

Use of dual RDTs rather than individual RDTs has potential to increase the number of pregnant women tested for syphilis and HIV by increasing availability, improving quality, and increasing demand. Use of an optical reader may improve diagnostic quality, and web linkage may allow for improved surveillance, procurement, and patient-tailored care algorithms for HIV and syphilis, as well as other diseases in the future.