July 2011

Study Shows Syphilis Rapid Testing and Treatment Can Prevent MTCT of Syphilis and HIV

July 19, 2011

Contact: Robert Yule, +1.202.390.9540; ryule@pedaids.org

Findings Already Being Incorporated in National Guidelines of Uganda and Zambia to Eliminate Syphilis and Pediatric HIV Infections

July 19, 2011, Rome, Italy – Study findings presented today at the 6th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention show that integrating rapid syphilis screening and HIV testing for pregnant women is feasible, cost-effective, and helps prevent both transmission of syphilis and HIV from mother-to-child.

The results of the study – conducted in Uganda and Zambia by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) – identified high rates of syphilis and HIV co-infection in pregnant women in both countries. In Uganda, 14.3% of syphilis-positive pregnant women also tested positive for HIV, and the rate was 24.2% in Zambia.

High co-infection rates of syphilis and HIV in pregnant women increases the risk of HIV transmission from mother-to-child. An HIV-positive pregnant woman with syphilis is twice as likely to pass HIV on to her baby compared to a woman infected with HIV alone. Like HIV, syphilis is a major cause of morbidity and mortality among women and children in resource-limited settings. Untreated syphilis during pregnancy is associated with a number of negative outcomes, such as stillbirth, premature delivery, low birth weight, and perinatal death. Unlike HIV, syphilis is curable with an affordable and accessible medicine, the antibiotic penicillin. Both HIV and syphilis are absolutely preventable by stopping mother-to-child transmission.

“Testing pregnant women for syphilis and HIV saves lives,” said Dr. Edward Bitarakwate, country director for Uganda for the Elizabeth Glaser Pediatric AIDS Foundation, and a co-author of the study. “This research underlines the importance of diagnosing pregnant women early and providing them with the proper treatment to prevent the transmission of syphilis and HIV to their infants.”

The study utilized new rapid syphilis testing in antenatal clinics that provide services for the prevention of mother-to-child transmission (PMTCT) of HIV in Uganda and Zambia. The new tests make it possible to screen more pregnant women for syphilis in a variety of urban and rural settings without the need for additional laboratory equipment or refrigeration.

“In Zambia, if we're going to be successful in eliminating pediatric AIDS, we have to also prevent congenital syphilis,” said Dr. Susan Strasser, the Elizabeth Glaser Pediatric AIDS Foundation’s country director for Zambia, and another co-author of the study. “Congenital syphilis can be easily diagnosed and cured thanks to rapid diagnostics and treatment. It is simply unacceptable for this disease to continue to plague women and children.”

The study showed that providing a total package of maternal and newborn health care, which includes screening and treatment for HIV and syphilis, is important to improving the health of pregnant women and their children. Early detection and prevention of congenital syphilis may significantly reduce the number of miscarriages, stillbirths, preterm and low-birth-weight infants, and early infant deaths.

The study also included a survey of health care workers to ensure that rapid syphilis testing could be incorporated into routine antenatal care and PMTCT services without any interruption or negative impact on service delivery or quality of care.

In both countries, the study sought to increase male involvement in the prevention and treatment of syphilis. As part of the Uganda study, male partners were encouraged to attend the clinic for syphilis and HIV testing with their partners, and invitation letters were sent home with women attending antenatal clinics. This resulted in a small but significant increase (from 9.8% to 12.5%) in men coming to the clinic with their partners for a package of care that included syphilis and HIV counseling and testing, syphilis treatment, and referral for HIV care. In Zambia, the study utilized a partner notification letter sent home with women who tested positive for syphilis to track the follow-up and treatment of male partners.

The study has led to rapid and direct policy change in both countries to further the goal of eliminating congenital syphilis and pediatric HIV and AIDS. The results have been presented to the ministries of health in Uganda and Zambia, which are now both incorporating rapid syphilis testing into their standard package of PMCT services and antenatal care.

The Elizabeth Glaser Pediatric AIDS Foundation conducted the study with support from the Sexually Transmitted Diseases Diagnostic Initiative (SDI) of the UNICEF/UNDP/World Bank/World Health Organization (WHO) Special Programme for Research and Training in Tropical Diseases (TDR), and with the support and coordination of the London School of Hygiene & Tropical Medicine (LSHTM). EGPAF worked in partnership with the Ministries of Health in Uganda and Zambia and the Centre for Infectious Disease Research in Zambia (CIDRZ).

“If we work together to stamp out congenital syphilis, an entirely preventable and treatable disease, we will go a long way to achieve the goal of reducing the under five mortality rate by two thirds as well as improving maternal health,” said Professor Rosanna Peeling, Chair of Diagnostics Research at the LSHTM, and one of the project leads.

The study was part of a larger, three-year project in seven countries conducted by the LSHTM and WHO, and funded by the Bill and Melinda Gates Foundation. Its goal was to determine the feasibility and cost-effectiveness of using rapid tests to increase access to syphilis screening in prenatal and high risk populations in resource-limited countries. The study in Uganda and Zambia was the only one to address the links between congenital syphilis and mother-to-child transmission of HIV.

“If countries could integrate syphilis screening with HIV screening, it would be more cost-effective and prevent babies dying of syphilis,” said Dr. Peter Piot, Director of the LSHTM.

The WHO has called for the elimination of mother-to-child transmission of HIV and syphilis, and the U.S. Centers for Disease Control and Prevention (CDC) has declared that the elimination of congenital syphilis is a winnable battle. The Americas and Africa are the focus of a strong, dual initiative to end both of these diseases in children.

To read more about the study in Uganda and Zambia, visit http://www.pedaids.org/Publications/Program-Briefs/QC_Syphilis_Brief_ltr_April2011_4web.

For more about the male involvement component of the study, visit http://www.pedaids.org/Publications/Program-Briefs/Syphilis_MaleInvolve_ltr_April2011_4web.


About the Elizabeth Glaser Pediatric AIDS Foundation:
The Foundation is a global leader in the fight against pediatric HIV and AIDS, and has reached more than 12.2 million women with services to prevent transmission of HIV to their babies. It currently works at more than 5,500 sites in 17 countries to implement prevention, care, and treatment services; to further advance innovative research; and to execute strategic and targeted global advocacy activities in order to bring dramatic change to the lives of millions of women, children, and families worldwide.