A case study of antenatal syphilis screening in South Africa - Successes and challenges

Background: To evaluate the process of providing routine syphilis screening to antenatal care (ANC) clients at primary healthcare clinics in KwaZulu-Natal Province, South Africa. Goal: To document the program performance and make recommendations for improving the current program and informing proposals for on-site testing. Study Design: Nine health facilities were recruited for the study. The methodology used for this case study included: Key informant interviews, inventory, focus group discussions with clients, client flow analysis, exit interviews with clients and observations of consultations. Results: All 51 women attending their first ANC visit had a blood sample taken for a syphilis rapid plasma reagin (RPR) test. Unreliable transport resulted in an average 4 weeks turnaround time to get RPR test results back to clinics. Due to late presentation in the pregnancy for their first ANC visit, 15% would have been unable to complete their treatment before delivery if they had been found positive. Health providers gave minimal information and/or counseling on syphilis, neither did they stress the importance of treatment of positive clients and their partners. There was no strategy to track positive clients who had not been treated or their partners. Providers were unclear on whether partners should be tested before treatment. Conclusion: Although testing was readily available, most of the constraints were centered round logistics of ensuring treatment of women and their partners. These issues must be addressed by sexually transmitted infection managers and policymakers.