Rita Revollo

Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project.

Objective:To implement an HIV prevention intervention among female commercial sex workers (CSW), and to monitor key outcomes using routinely collected clinical and laboratory data. Design:Cross-sectional and longitudinal analysis of data from an open-enrollment cohort. Setting:One public sexually transmitted disease (STD) clinic and about 25 brothels in La Paz, Bolivia. Participants:A total of 508 female CSW who work at brothels and attend a public STD clinic. Intervention:Improved STD clinical care, supported by periodic laboratory testing, and behavioral interventions performed by a local non-governmental organization. Main outcome measures:Prevalence of gonorrhea, syphilis (reactive plasma reagin titer ≥ 1 : 16), genital ulcer disease, chlamydial infection, and trichomoniasis; self-reported condom use in the previous month; and HIV seroprevalence. Results:From 1992 through 1995, prevalence of gonorrhea among CSW declined from 25.8 to 9.9% (P < 0.001), syphilis from 14.9 to 8.7% (P = 0.02), and genital ulcer disease from 5.7 to 1.3% (P = 0.006); trends in prevalence of chlamydial infection and trichomoniasis were not significant. Self-reported condom use during vaginal sex in the past month increased from 36.3 to 72.5% (P < 0.001). In a multivariate analysis, condom use was inversely associated with gonorrhea [odds ratio (OR), 0.63; 95% confidence interval (CI), 0.41–0.97], syphilis (OR, 0.39; 95% CI, 0.23–0.64), and trichomoniasis (OR, 0.44; 95% CI, 0.32–0.71). In 1995, HIV seroprevalence among CSW was 0.1%. Conclusion:Effective prevention interventions for female CSW can be implemented through public services and non-governmental organizations while HIV rates are still low, and key outcomes can be monitored using data obtained from periodic screening examinations.

Diagnostic accuracy of a point-of-care syphilis test when used among pregnant women in Bolivia

Objective: To evaluate the performance of a point-of-care (POC) syphilis test when used in urban Bolivian maternity hospitals. Methods: We tested 8892 pregnant women for syphilis using the Abbott Determine Syphilis TP rapid POC test and rapid plasma reagin (RPR) in the laboratory of four large urban maternity hospitals where national statistics reported a syphilis prevalence of at least 3%. Sera were stored and transferred to the national reference laboratory (INLASA) where RPR testing was repeated. When the reference laboratory staff observed a positive RPR result, a Treponema pallidum particle agglutination assay (TPPA) was performed to confirm these findings. We calculated test performance characteristics for the POC test and hospital RPR using RPR performed at the reference laboratory confirmed by TPPA as the reference standard. Participants received treatment during their initial visit based on the POC test results. Results: The sensitivity, specificity, negative predictive value and positive predictive values of the POC syphilis test were: 91.8% (95% confidence intervals 88.4% to 94.5%), 98.5% (98.2% to 98.8%), 71.0% (66.6% to 75.2%), and 99.7% (99.5% to 99.8%), respectively. The RPR values were 75.7% (70.8% to 80.2%), 99.0% (98.9% to 99.3%), 76.9% (72.0% to 81.3%), and 99.0% (98.8% to 99.2%), respectively. Conclusion: The Abbott Determine Syphilis TP test proved to be more sensitive than routine RPR and had comparable specificity. POC testing may be a simple way to expand syphilis screening to clinics with no laboratory facilities, improve case detection, and facilitate treatment delivery.

Analysis of the operational costs of using rapid syphilis tests for the detection of maternal syphilis in Bolivia and Mozambique.

Objective: The objective of this study was to compare the costs of antenatal syphilis screening with the rapid plasma reagin (RPR) test and the immunochromatographic strip (ICS) test in low-resource settings. Goal: The goal of this study was to assess the costs of introducing rapid syphilis tests to reduce maternal and congenital syphilis. Study Design: Cost data were collected from participating study hospitals and antenatal clinics during 4 field visits to the 2 countries in 2003 and 2004. Health utilization outcome data on the number of women screened and treated routinely during the demonstration projects were used with unit cost data to estimate the incremental costs and average cost per woman screened and treated for maternal syphilis. Results: In Mozambique, the average cost per woman screened was U.S.

Sífilis materna y congénita en cuatro provincias de Bolivia

0.91 and U.S.

Demonstrating public health at work: a demonstration project of congenital syphilis prevention efforts in Bolivia.

1.05 for the RPR and ICS tests, respectively. In Bolivia, the average cost of screening was U.S.

Maternal syphilis and intimate partner violence in Bolivia: a gender-based analysis of implications for partner notification and universal screening.

1.48 and U.S.

Contraception and Condom Use Among Bolivian Female Sex Workers: Relationship-Specific Associations Between Disease Prevention and Family Planning Behaviors

1.91 using the RPR and ICS test, respectively. In health centers without laboratories, the cost per woman screened using the ICS test ranged from U.S.

The co-occurrence of intimate partner violence and syphilis among pregnant women in Bolivia.

1.02 in Mozambique to U.S.

Maternal syphilis and intimate partner violence in Bolivia

2.84 in Bolivia. Conclusions: It is feasible to introduce rapid syphilis testing in settings without laboratory services at a small incremental cost per woman screened. In settings with laboratories, the cost of ICS is similar to that of RPR.

P3.79 Barriers for syphilis screening in bolivia

Objective. Assess frequencies of maternal and congenital syphilis, mother-child transmission and variables associated with syphilis in six urban hospitals in Bolivia. Material and Methods. A cross-sectional study was performed between May and September 2004. We administered the Abbot De- termine-TP rapid test and quantitative RPR to postpartum women without prior RPR. Sociodemographic variables and prior prenatal care visits were studied. Newborns of syphilis positive mothers were studied with Western Blot IgM p47 and ELISA IgM. Serum samples were analyzed at the Central Reference Laboratory (INLASA). Statistical analysis included bivariate and multivariate analyses to establish association with positive diagnosis of T. pallidum. Results. Syphilis prevalence among 1 594 postpartum women was 7.2%. Mother to child transmission was 15.7%. Congenital syphilis prevalence by serology was 1.1% and 94% of these newborns displayed no symptoms. Despite 70.5% prenatal care coverage in Bolivia some women still go directly to a facility to give birth without prior routine tests for syphilis. Low education levels in both parents (< 8 years) and failure to attend prenatal care were strong predictors of congenital syphilis. Conclusions. Rapid syphilis tests constitute an important tool to strengthen early diagnosis of syphilis dur - ing pregnancy. Preventing congenital and maternal syphilis in Bolivia remains a public health priority.