Syphilis Screening and Treatment for Pregnant Women
APPROXIMATELY ONE MILLION PREGNANT WOMEN AROUND THE WORLD ARE INFECTED WITH ACTIVE SYPHILIS. BY PREVENTING MOTHER-TO-CHILD TRANSMISSION OF SYPHILIS, WE CAN AVERT THOUSANDS OF CASES OF
NEONATAL MORTALITY AND DISABILITY EVERY YEAR.
Each year, mother-to-child transmission of syphilis, called congenital syphilis, results in a combined 200,000 stillbirths and neonatal deaths globally — more than the child mortality caused by HIV — as well as over 100,000 cases of disability in children, including blindness, neurological issues, and hearing loss.
Much of this suffering is treatable with a single inexpensive benzathine penicillin injection, which can prevent over 80% of the adverse outcomes to the child. Yet prevention of congenital syphilis remains deeply neglected globally, despite the severe health burden it places on children.
We are seeking to change this paradigm by working with governments to adopt and scale rapid HIV/syphilis dual testing in prenatal care settings, dramatically increasing countries’ ability to detect and treat the disease before it causes complications to the child.
1/3 OF ALL ADVERSE OUTCOMES
INCLUDING OVER 50,000 STILLBIRTHS AND 20,000 NEONATAL DEATHS, COULD BE PREVENTED BY ADOPTING HIV/SYPHILIS DUAL TESTING IN HIGH BURDEN COUNTRIES.
A Cost-Effective Solution
COUNTRIES CAN LEVERAGE A DECADES-LONG INVESTMENT IN PROGRAMS PREVENTING MOTHER-TO-CHILD HIV TRANSMISSION TO SIMULTANEOUSLY ADDRESS CONGENITAL SYPHILIS.
Switching from an HIV-only test to an HIV/syphilis dual test costs an additional US$0.35, and combined with delivering a penicillin injection to women found to be infected—each dose costing less than US$0.50—thousands of childrens’ lives can be saved within the next few years.
HIV/syphilis dual tests can be easily administered by midwives and nurses during prenatal visits, require only a single fingerstick, and yield clear results within 15 minutes. These tests can be deployed within existing HIV infrastructure, do not compromise accuracy in HIV testing, and enable syphilis screening where it has been largely non-existent for decades. In 2019, the World Health Organization officially recommended that pregnant women who attend antenatal care be screened for HIV using an HIV/syphilis dual test.
A simple benzathine penicillin shot is highly effective in reducing the risks associated with maternal syphilis. Studies show that a single dose administered before a woman’s third trimester dramatically reduces the risk of adverse outcomes, including:
82% REDUCTION IN THE RISK
OF STILLBIRTH DURING PREGNANCY
80% REDUCTION IN THE RISK
OF NEONATAL DEATH
60% REDUCTION IN THE RISK
OF BEING BORN AT A LOW BIRTH WEIGHT
96% REDUCTION IN THE RISK OF PHYSICAL
AND COGNITIVE DISABILITY CAUSED
BY HAVING SYPHILIS AT BIRTH
Preventing Congenital Syphilis in Liberia
This intervention was identified and selected by Evidence Action’s Accelerator under our New Program Development process, where the evidence for interventions is rigorously evaluated so that only those with the greatest potential for cost-effective impact are scaled up.
Our first partnership is with the Government of Liberia, where we are testing a technical assistance model to help the government replace its existing HIV tests with HIV/syphilis dual tests and strengthen its capacity to deliver the treatment.
The current screening rate for syphilis among pregnant women in Liberia stands at 6%. With our support, the government is targeting to reach 80% of pregnant women, or 190,000 women per year, within five years. Our program is funded and recommended by GiveWell for the high potential for cost-effective impact.
If proven successful, there are a number of countries globally that have a significant burden of congenital syphilis and could benefit from support to adopt the dual test.
IMPACT POTENTIAL
NUMBER OF PREGNANT WOMEN WHO WOULD GAIN ACCESS TO SYPHILIS TESTING AND TREATMENT AFTER THE DUAL TEST IS INTRODUCED
*Estimates based on publicly available health and population data
The Evidence for Testing and Treating Congenital Syphilis
The efficacy of the treatment for congenital syphilis has been researched for several decades; however, there has been little advancement in implementing effective screening and treatment programs within antenatal care settings. Here is a summary of key research studies:
- A meta-analysis concluded at least 80% of adverse events of congenital syphilis could be prevented with a single injection of benzathine penicillin administered up to 28 days before delivery.
- Disease modeling incorporating data from 195 countries estimates that in 2016, over two-thirds of adverse outcomes of congenital syphilis occurred among women who attended prenatal care but lacked access to screening and treatment.
- A recent randomized control trial in the Democratic Republic of Congo and Zambia showed that the availability of syphilis point-of-care testing results in immediate increases in syphilis screening and treatment coverage among pregnant women.
Our Partnership Model
EVIDENCE ACTION SUPPORTS GOVERNMENTS THROUGH A TECHNICAL ASSISTANCE MODEL, WHERE WE PROVIDE COMPREHENSIVE SUPPORT TO SCALE HIV/SYPHILIS DUAL TESTING AND STRENGTHEN SYPHILIS TREATMENT, WITH FOCUS IN FIVE CORE AREAS:
Strengthening policy, program management, and coordination
Piloting dual testing and developing operational plans for national scale-up; providing technical guidance in policy revision; and coalition-building among HIV and maternal and child health stakeholders.
Enhancing supply chain management
Identifying and implementing solutions to distribution bottlenecks, gap-filling commodity procurement, and data-driven commodity forecasting.
Strengthening data collection and monitoring
Identifying key performance indicators, improving existing national data collection tools, developing a programmatic learning agenda and sharing results to help drive process improvement.
Supporting healthcare provider training and supervision
Developing curriculum, job aids, and other healthcare provider tools, and providing financial support for capacity building activities.
Identifying and securing funding
Supporting government applications to Global Fund, PEPFAR, and identifying long-term funding within government budgets.
