Better care for babies: the added value of a modified reverse syphilis testing algorithm for the treatment of congenital syphilis in a maternity Hospital in Central African Republic
Background In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - R...
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| Veröffentlicht in: | BMC pediatrics Jg. 19; H. 1; S. 284 - 10 |
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| Format: | Journal Article |
| Sprache: | Englisch |
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BioMed Central
15.08.2019
BioMed Central Ltd BMC |
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| ISSN: | 1471-2431, 1471-2431 |
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| Abstract | Background
In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns.
Methods
The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization.
Results
Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04–0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00–1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing.
Conclusions
This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections. |
|---|---|
| AbstractList | Background
In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns.
Methods
The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization.
Results
Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04–0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00–1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing.
Conclusions
This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections. Background In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns. Methods The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization. Results Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04-0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00-1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing. Conclusions This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections. Keywords: Congenital, Syphilis, Non-treponemal, Operational research, Central African Republic, Low resource In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns.BACKGROUNDIn high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns.The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization.METHODSThe study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization.Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04-0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00-1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing.RESULTSOf 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04-0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00-1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing.This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections.CONCLUSIONSThis testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections. Abstract Background In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns. Methods The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization. Results Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04–0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00–1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing. Conclusions This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections. In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns. The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization. Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04-0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00-1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing. This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections. In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10 days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns. The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization. Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR) = 0.20; 95% Confidence interval (CI) = 0.04-0.92] and 9% more likely to be discharged [RR = 1.09; 95% CI = 1.00-1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing. This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections. |
| ArticleNumber | 284 |
| Audience | Academic |
| Author | Zuniga, Isabel Caluwaerts, Severine Ogundipe, Oluwakemi F. Thierry, Behounde Van den Bergh, Rafael Chaillet, Pascale Takarinda, Kudakwashe C. Timire, Collins Muller, Claude P. |
| Author_xml | – sequence: 1 givenname: Oluwakemi F. orcidid: 0000-0001-8894-744X surname: Ogundipe fullname: Ogundipe, Oluwakemi F. email: Oluwakemi.ogundipe@brussels.msf.org organization: Médecins Sans Frontières, Operational Centre Brussels – sequence: 2 givenname: Rafael surname: Van den Bergh fullname: Van den Bergh, Rafael organization: Médecins Sans Frontières, Operational Centre Brussels – sequence: 3 givenname: Behounde surname: Thierry fullname: Thierry, Behounde organization: Ministry of Health – sequence: 4 givenname: Kudakwashe C. surname: Takarinda fullname: Takarinda, Kudakwashe C. organization: International Union Against Tuberculosis and Lung Disease, Ministry of Health and Child Care, AIDS and TB Department, International Union Against Tuberculosis and Lung Disease – sequence: 5 givenname: Claude P. surname: Muller fullname: Muller, Claude P. organization: Luxembourg Institute of Health, Esch-Alzette, and Laboratoire National de Santé – sequence: 6 givenname: Collins surname: Timire fullname: Timire, Collins organization: International Union Against Tuberculosis and Lung Disease, Ministry of Health and Child Care, AIDS and TB Department, International Union Against Tuberculosis and Lung Disease – sequence: 7 givenname: Severine surname: Caluwaerts fullname: Caluwaerts, Severine organization: Médecins Sans Frontières, Operational Centre Brussels – sequence: 8 givenname: Pascale surname: Chaillet fullname: Chaillet, Pascale organization: Médecins Sans Frontières, Operational Centre Brussels – sequence: 9 givenname: Isabel surname: Zuniga fullname: Zuniga, Isabel organization: Médecins Sans Frontières, Operational Centre Brussels |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31416437$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1136/sti.79.5.375 10.2471/BLT.12.107623 10.1097/OLQ.0000000000000291 10.1136/sti.2006.022640 10.1371/journal.pone.0211720 10.1016/S2214-109X(17)30362-5 10.7759/cureus.2078 10.1097/OLQ.0b013e3182260987 10.1016/j.ijgo.2015.04.012 10.2105/AJPH.91.5.705 |
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| Keywords | Low resource Operational research Central African Republic Congenital Syphilis Non-treponemal |
| Language | English |
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| References_xml | – volume: 79 start-page: 375 issue: 5 year: 2003 ident: 1622_CR15 publication-title: Sex Transm Infect doi: 10.1136/sti.79.5.375 – ident: 1622_CR18 – ident: 1622_CR22 – volume-title: The global elimination of congenital syphilis: rationale and strategy for action year: 2007 ident: 1622_CR3 – ident: 1622_CR6 – ident: 1622_CR10 – volume: 91 start-page: 217 issue: 3 year: 2013 ident: 1622_CR4 publication-title: Bull World Health Organ doi: 10.2471/BLT.12.107623 – ident: 1622_CR7 – volume: 8 start-page: e525 issue: 3 year: 2016 ident: 1622_CR16 publication-title: Cureus. – ident: 1622_CR19 – volume: 42 start-page: 369 issue: 7 year: 2015 ident: 1622_CR13 publication-title: Sex Transm Dis doi: 10.1097/OLQ.0000000000000291 – ident: 1622_CR21 – ident: 1622_CR17 – ident: 1622_CR11 – volume: 82 start-page: v17 issue: suppl_5 year: 2006 ident: 1622_CR25 publication-title: Sexually Transmitted Infections doi: 10.1136/sti.2006.022640 – volume: 14 start-page: e0211720 issue: 2 year: 2019 ident: 1622_CR1 publication-title: PLoS One doi: 10.1371/journal.pone.0211720 – volume-title: Investment case for eliminating mother-to-child transmission of syphilis. Promoting better maternal and child health and stronger health systems year: 2012 ident: 1622_CR9 – volume: 5 start-page: e1066 issue: 11 year: 2017 ident: 1622_CR23 publication-title: The Lancet Global Health doi: 10.1016/S2214-109X(17)30362-5 – ident: 1622_CR24 doi: 10.7759/cureus.2078 – ident: 1622_CR8 – volume: 38 start-page: 997 issue: 11 year: 2011 ident: 1622_CR12 publication-title: Sex Transm Dis doi: 10.1097/OLQ.0b013e3182260987 – volume: 130 start-page: S10 issue: Suppl 1 year: 2015 ident: 1622_CR5 publication-title: Int J Gynaecol Obstet doi: 10.1016/j.ijgo.2015.04.012 – volume: 91 start-page: 705 issue: 5 year: 2001 ident: 1622_CR14 publication-title: Am J Public Health doi: 10.2105/AJPH.91.5.705 – start-page: 775 volume-title: American Academy of Pediatrics Committee on Infectious Diseases. Red book: 2018 report of the committee on infectious diseases year: 2018 ident: 1622_CR2 – volume: 26 start-page: 192 issue: 2 year: 2016 ident: 1622_CR20 publication-title: Med Sante Trop |
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In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of... In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over... Background In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of... Abstract Background In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the... |
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| SubjectTerms | Algorithms Anti-Bacterial Agents - therapeutic use Care and treatment Central African Republic Cohort Studies Congenital Congenital syphilis Control Female Genetic disorders Hospitals, Maternity Humans Infant, Newborn Infants Internal Medicine Low resource Male Management science Medicine Medicine & Public Health Neonatology Newborn infants Non-treponemal Operational research Pediatrics Penicillins Pregnancy Pregnancy Complications, Infectious - diagnosis Pregnancy Complications, Infectious - drug therapy Research Article Retrospective Studies Risk factors Sexually transmitted diseases Syphilis Syphilis - diagnosis Syphilis - drug therapy Syphilis Serodiagnosis - methods Syphilis test Syphilis, Congenital - diagnosis Syphilis, Congenital - drug therapy |
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| Title | Better care for babies: the added value of a modified reverse syphilis testing algorithm for the treatment of congenital syphilis in a maternity Hospital in Central African Republic |
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