Table 2.
Thematic framework, personnel interviewed and key findings of investigation of syphilis POC testing policy in Ghana
| Themes and sub-themes | Personnel interviewed | Key findings |
|---|---|---|
| 1. Uptake and successes | ||
| • Syphilis testing for pregnant women | Facility in-charges, midwives and laboratory technologists | Almost all facilities were performing syphilis tests for pregnant women either at the antenatal clinic or laboratory Two facilities could not start syphilis testing due to lack of/expired test kits |
| • Successes | Facility in-charges, midwives, pharmacists and laboratory technologists | Decentralisation of syphilis testing Free syphilis testing and treatment for pregnant women |
| 2. Staff training and facility level preparedness for rollout of treponemal POCTs | ||
| • Awareness of policy on antenatal syphilis screening | Facility in-charges, medical officers and midwives | All respondents aware of the need to screen all pregnant women for syphilis |
| • Knowledge of consequences of untreated maternal syphilis | Facility in-charges, medical officers and midwives | Almost all staff knew of an adverse pregnancy outcome due to maternal syphilis Considered knowledge of the consequences of untreated maternal syphilis to be essential in counselling |
| • Training and retraining in the use of treponemal POCTs | Facility in-charges, midwives, laboratory technologists and STI coordinator | Midwives trained in all facilities Issues with quality of training (compared to HIV training): duration, content, practical demonstration and interpretation of test results Lack of standard operating procedures No re-retraining/refresher training after the initial training |
| • Antenatal syphilis screening, treatment and referral guidelines | Facility in-charges, midwives, lab technologists and STI coordinator | No guidelines for antenatal syphilis screening Syphilis treatment protocols available in only two facilities No referral guidelines for syphilis screening and treatment Screening and treatment guidelines/protocols for other maternal and newborn interventions displayed at vantage points in facilities No partner notification cards/slips for STIs (including syphilis & HIV) |
| 3. Staff experiences and challenges | ||
| • Maternal syphilis as a component of health education during pregnancy | Midwives | All but one facility discussed maternal syphilis during health education sessions for pregnant women |
| • Experience of performing HIV and syphilis tests together | Midwives | Easier and time saving for healthcare providers Good counselling required for a clear understanding and interpretation of HIV and syphilis test results Convenient for pregnant women |
| • Challenges | All | Stockouts of syphilis test kits and benzathine penicillin Inadequate staff/work overload Poor documentation of syphilis test results and treatment Lack of supervision and quality checks |
ANC - Antenatal care; POCT – Point of care test; STI - Sexually transmitted infection