Introducing onsite antenatal syphilis screening in Burkina Faso: implementation and evaluation of a feasibility intervention tailored to a local context

Fadima Yaya Bocoum, Grissoum Tarnagda, Fabrice Bationo, Justin R Savadogo, Sarata Nacro, Séni Kouanda, Christina Zarowsky, Fadima Yaya Bocoum, Grissoum Tarnagda, Fabrice Bationo, Justin R Savadogo, Sarata Nacro, Séni Kouanda, Christina Zarowsky

Abstract

Background: Although the advantages of introducing point of care testing for syphilis in antenatal care (ANC) are well documented, there is little evidence on how to address structural issues within health systems. A better understanding of how these interventions work in a range of settings and contexts is needed in order to overcome bottlenecks at health system level. To better understand the relationships between implementation and context we developed and implemented an intervention focused on integrating a rapid screening test for syphilis in ANC services in rural primary health care facilities in Burkina Faso. This manuscript describes the intervention and reports on feasibility and acceptability of the intervention, the facilitators and barriers to the implementation of this intervention and the likelihood that point of care test for syphilis will become routinely incorporated in practice.

Methods: In Kaya Health and Demographic Surveillance System (Kaya HDSS), all 7 primary healthcare facilities were selected for intervention in 2013. A participatory approach was used to design and implement an antenatal syphilis screening intervention. The Normalization Process Model (NPM) proposed by May et al. was adapted in order to identify barriers and facilitators and to explore the likelihood to become routinely incorporated in practice. Registers, Observations (n = 14 ANC 1) of interactions between patients and health workers during ANC and interviews with health workers (n = 14) were our data sources.

Results: An intervention that included onsite training, provision of supplies and medicines, quality control and supervision was implemented in 7 health facilities in 2013. Rapid syphilis test and treatment were delivered during ANC within the examination room with no specific additional mechanism regarding staff organization. The perceived barriers were lack of training of all staff, workload, stock-outs of consumables and lack of motivation of staff. Key facilitators included political environment, ease of use of test and acceptability to pregnant women.

Conclusions: Onsite testing for antenatal syphilis is a feasible and acceptable intervention in ANC at primary health facility in Burkina Faso. The point-of care test for syphilis is more likely to be acceptable by health workers as routine service and incorporated as a normal practice.

Trial registration: The study was retrospectively registered on ClinicalTrials.gov under the Trial Registration Number NCT03156751 .

Keywords: Antenatal care; Burkina Faso; Feasibility; Point of care test; Screening; Syphilis.

References

    1. Genc M, Ledger W. Syphilis in pregnancy. Sex Transm Infect. 2000;76:73–79. doi: 10.1136/sti.76.2.73.
    1. Walker DG, Walker GJA. Prevention of congenital syphilis--time for action. Bull World Health Organ. 2004;82:401. Available from: .
    1. WHO . The global elimination of congenital syphilis: rationale and strategy for action. Geneva: WHO; 2007.
    1. Kamb ML, Newman LM, Riley PL, Mark J, Hawkes SJ, Malik T, et al. A road map for the global elimination of congenital syphilis. Obstet. Gynecol. Int. 2010 [cited 2012 Dec 21];2010. Available from: .
    1. PSSLS-IST. Rapport de la sérosurveillance 2011 par sites sentinelles chez les femmes enceintes au Burkina Faso. Ouagadougou, Burkina Faso: Ministère de la Santé; 2013.
    1. WHO. Guidelines for the management of sexually transmitted infections. Geneva: WHO; 2001.
    1. Control Centers for Disease Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002;51:1–78.
    1. Gloyd S, Chai S, Mercer MA. Antenatal syphilis in sub-Saharan Africa: missed opportunities for mortality reduction. Health Policy Plan. 2001;16:29–34. Available from: .
    1. Deperthes BD, Meheus A, O’Reilly K, Broutet N. Maternal and congenital syphilis programmes: case studies in Bolivia, Kenya and South Africa. Bull World Health Organ. 2004;82:410–6. Available from: .
    1. Yaya Bocoum F, Kouanda S, Zarowsky C. Barriers to antenatal syphilis screening in Burkina Faso. Pan Afr Med J. 2014;17(Suppl 1):12. [cited 2014 Mar 24]. Available from: .
    1. WHO/TDR. The Use of Rapid Syphilis Tests. World Health Organization (WHO). Geneva: WHO; 2006. Available from: .
    1. Yaya Bocoum F, Ouédraogo H, Tarnagda G, Kiba A, Tiendrebeogo S, Bationo F, et al. Evaluation of the diagnostic performance and operational characteristics of four rapid immunochromatographic syphilis tests in Burkina Faso. Afr J Health Sci. 2015;15:1–4.
    1. Shahrook S, Mori R, Ochirbat T, Gomi H. Strategies of testing for syphilis during pregnancy. Cochrane Database Syst Rev. 2013:37. Available from: doi:10.1002/14651858.CD010385/abstract.
    1. Kahn JG, Jiwani A, Gomez GB, Hawkes SJ, Chesson HW, Broutet N, et al. The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model. PLoS Negl Trop Dis. 2014;9:1–10.
    1. Terris-Prestholt F, Vickerman P, Torres-Rueda S, Santesso N, Sweeney S, Mallma P, et al. The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia. Int J Gynecol. 2015;16–20. Available from: .
    1. Kuznik A, Lamorde M, Nyabigambo A, Manabe YC. Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis. PLoS Med. 2013;10(11):e1001545. doi: 10.1371/journal.pmed.1001545.
    1. Hawkes S, Matin N, Broutet N, Low N. Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis. 2011;11:684–91. [cited 2012 Dec 22]. Available from: .
    1. Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, et al. Designing and evaluating complex interventions to improve health care. BMJ Br Med J. 2007;334:455–459. doi: 10.1136/.
    1. Craig P, Dieppe P, Macintyre S, Mitchie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions : the new medical research council guidance. BMJ. 2008;337:979–983. doi: 10.1136/bmj.a979.
    1. Kouanda S, Bado A, Yaméogo M, Nitiema J, Yaméogo G, Bocoum F, et al. The Kaya HDSS, Burkina Faso : a platform for epidemiological studies and health programme evaluation. Intrnational J Epidemiol. 2013;42:741–749. doi: 10.1093/ije/dyt076.
    1. Yaya Bocoum F, Ouédraogo HG, Tarnagda G, Kiba A, Tiendrebeogo S, Bationo F, Liestman B, et al. Evaluation of the diagnostic performance and operational characteristics of four rapid immunochromatographic syphilis tests in Burkina Faso. Afr J Health Sci. 2015;15(2):360–7.
    1. May C, Finch T, Mair F, Ballini L, Dowrick C, Eccles M, et al. Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Serv Res. 2007;7:148. doi: 10.1186/1472-6963-7-148.
    1. Munkhuu B, Liabsuetrakul T, McNeil E, Janchiv R. Feasibility of one-stop antenatal syphilis screening in ulaanbaatar, mongolia: Women and providers perspectives. Southeast Asian J. Trop. Med. Public Health. 2009;40:861–870.
    1. Tucker JD, Hawkes SJ, Yin Y-P, Peeling RW, Cohen MS, Chen X-S. Scaling up syphilis testing in China: implementation beyond the clinic. Bull World Health Organ. 2010;88:452–7. [cited 2013 Jan 16]. Available from: .
    1. García SG, Tinajeros F, Revollo R, Yam EA, Richmond K, Díaz-Olavarrieta C, et al. Demonstrating public health at work: a demonstration project of congenital syphilis prevention efforts in Bolivia. Sex Transm Dis. 2007;34:S37–41. [cited 2012 Dec 26]. Available from: .
    1. García PJ, Cárcamo CP, Chiappe M, Valderrama M, La Rosa S, Holmes KK, et al. Rapid syphilis tests as catalysts for health systems strengthening: a case study from Peru. PLoS ONE. 2013;8(6):e66905. doi: 10.1371/journal.pone.0066905.
    1. Elizabeth Glaser Foundation . Rapid syphilis testing study in Zambia and Uganda. Washington DC: The Elizabeth Glaser Pediatric AIDS Foundation; 2011. p. 4.
    1. Watson-Jones D, Oliff M, Terris-Prestholt F, Changalucha J, Gumodoka B, Mayaud P, et al. Antenatal syphilis screening in sub-Saharan Africa: lessons learned from Tanzania. Trop Med Int Heal. 2005;10:934–943. doi: 10.1111/j.1365-3156.2005.01473.x.
    1. Bonawitz RE, Duncan J, Hammond E, Hamomba L, Nambule J, Sambambi K, et al. Assessment of the impact of rapid syphilis tests on syphilis screening and treatment of pregnant women in Zambia. Int J Gynecol Obstet. 2015;0–4. Available from: .
    1. Bronzan RN, Mwesigwa-Kayongo DC, Narkunas D, Schmid GP, Neilsen GA, Ballard RC, et al. On-site rapid antenatal syphilis screening with an immunochromatographic strip improves case detection and treatment in rural South African clinics. SexTransm Dis. 2007;34:S55–S60.
    1. Fleming E, Oremo J, Connor KO, Odhiambo A, Ye T, Oswago S, et al. The impact of integration of rapid syphilis testing during routine antenatal services in rural Kenya. J Sex Transm Dis. 2013;2013:7.
    1. Dassah ET, Adu-Sarkodie Y, Mayaud P. Factors associated with failure to screen for syphilis during antenatal care in Ghana: a case control study. BMC Infect Dis. 2015;15:1–9. doi: 10.1186/s12879-015-0868-1.
    1. Yaya Bocoum F, Kouanda S, Kouyaté B, Hounton S, Adam T. Exploring the effects of task shifting for HIV through a systems thinking lens: the case of Burkina Faso. BMC Public Health. 2013;13:997. doi: 10.1186/1471-2458-13-997.
    1. Alam N, Chamot E, Vermund SH, Streatfield K, Kristensen S. Partner notification for sexually transmitted infections in developing countries: a systematic review. BMC Public Health. 2010;10:19. Available from: .
    1. McNutt L-A, Coles FB. Partner notification for gonorrhea--time for new ideas? Sex Transm Dis. 2007;34:834. doi: 10.1097/OLQ.0b013e3181559c4c.
    1. World Health Organisation. Integrated health services-what and why?. Tech. Br. Geneva; 2008. Report No.: 1. Available from: .
    1. Ridde V. Per diems undermine health interventions, systems and research in Africa : burying our heads in the sand. Trop Med Int Heal. 2010;0:1–4.
    1. Israr SM. Project mentality: a threat to effective implementation and sustainability of donor funded projects in Pakistan. J Pakistan Med Assoc. 2005;55:457–458.
    1. Zongo S, Ridde V, Haddad S. Les tests de diagnostic rapide (TDR) du paludisme : entre directives officielles et réalités d’ utilisation au Burkina Faso. 2013.
    1. Pembe AB, Carlstedt A, Urassa DP, Lindmark G, Nyström L, Darj E. Quality of antenatal care in rural Tanzania: counselling on pregnancy danger signs. BMC Pregnancy Childbirth. 2010;10:35. Available from: .
    1. Angotti N, Dionne KY, Gaydosh L. An offer you can’t refuse? provider-initiated HIV testing in antenatal clinics in rural Malawi. Health Policy Plan. 2011;26:307–15. [cited 2012 Dec 26]. Available from: .
    1. Munkhuu B, Liabsuetrakul T, Chongsuvivatwong V, McNeil E, Janchiv R. One-stop service for antenatal syphilis screening and prevention of congenital syphilis in Ulaanbaatar, Mongolia: a cluster randomized trial. Sex Transm Dis. 2009;36:714–720. doi: 10.1097/OLQ.0b013e3181bc0960.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe