Background
In 2022 there were approximately 130,000 child HIV infections and 700,000 cases of congenital syphilis globally. Through concerted effort substantial progress has been made in both HIV and syphilis testing coverage to identify infections in pregnancy and to offer treatment. However, gaps remain, including the gap between HIV and syphilis testing. Dual HIV/syphilis rapid tests can help close this testing gap and are recommended by WHO as the first test in antenatal care (ANC). We hypothesized that global dual test procurement is increasing rapidly, and that countries with dual testing policies for ANC also report higher syphilis testing coverage.
Methods
We collected and analyzed procurement data from the Global Fund (GF) to understand recent trends in dual test procurement. We also analyzed country-reported data on HIV and syphilis policy uptake and testing coverage from the Global AIDS Monitoring (GAM) platform to test the association between dual HIV/syphilis test policy uptake and reported syphilis testing coverage in countries consistently reporting between 2021-2023 using a mixed effects logistic regression with a random effect for country to account for repeated measurement.
Results
Data from 38 countries were included in the procurement analysis and 52 in the comparison of coverage by policy uptake status. Dual HIV/syphilis test procurement by the GF increased by 192% from 7.5 million tests in 2021 to a forecast 21.9 million in 2024, constituting over 30% of GF’s direct HIV test procurement in 2024 (Figure 1a). In 2023, of the 52 countries that reported to GAM the average HIV testing coverage was 92% and syphilis testing coverage 80% (Figure 1b); countries that reported adoption of dual HIV/syphilis testing in ANC had higher syphilis testing coverage than countries that did not report adoption. Pregnant women in countries that reported dual test uptake from 2021-23 were 28% more likely (odds ratio: 1.28; 1.27-1.29) to be tested for syphilis compared with pregnant women in countries that did not use the dual test (p-value <0.05).
Conclusions
Procurement of dual HIV/syphilis rapid tests is accelerating. While gaps between HIV and syphilis testing coverage persist, policy adoption of dual HIV/syphilis testing in ANC is associated with higher reported syphilis testing coverage. Limitations in the data include limited procurement data sources and weak syphilis reporting systems.