Building Health System Capacity Through Implementation Research: Experience of INSPIRE-A Multi-country PMTCT Implementation Research Project.

BACKGROUND: The INSPIRE-Integrating and Scaling Up PMTCT through Implementation REsearch-initiative was established as a model partnership of national prevention of mother-to-child transmission of HIV (PMTCT) implementation research in 3 high HIV burden countries-Malawi, Nigeria, and Zimbabwe. INSPIRE aimed to link local research groups with Ministries of Health (MOH), build local research capacity, and demonstrate that implementation research may contribute to improving health care delivery and respond to program challenges. METHODOLOGY: We used a mixed methods approach to review capacity building activities, as experienced by health care workers, researchers, and trainers conducted in the 6 INSPIRE projects before and during study implementation. RESULTS: Between 2011 and 2016, over 3400 health care workers, research team members, and community members participated in INSPIRE activities. This included research prioritization exercises, proposal development, good clinical practice and research ethics training, data management and analysis workshops, and manuscript development. Health care workers in clinics and district health offices acknowledged the value of hosting implementation research projects and how the quality of services improved. Research teams acknowledged the opportunities that projects provided for personal development and the value of participating in a multicountry research network. DISCUSSION: INSPIRE provided an opportunity for African-led research in which researchers worked closely with national MOH to identify priority research questions and implement studies. Close partnerships between research teams and local implementers facilitated project responsiveness to local program issues. Consequently, processes and training needed for study implementation also improved local program management and service delivery. Additional benefits included improved data management, publications, and career development.

Laboratory evaluation of three dual rapid diagnostic tests for HIV and syphilis in China and Nigeria.

OBJECTIVE: To determine the laboratory-based performance and operational characteristics of three dual rapid diagnostic tests (RDTs) for testing HIV and syphilis. METHODS: Three dual RDTs (SD Bioline, Chembio, and MedMira) were evaluated using 1514 serum specimens archived at laboratories or collected from clinics in China and Nigeria to determine sensitivity and specificity, with 95% confidence intervals. Concordance of testing results read by two technicians, stability of testing results read at two time points, and test operation characteristics were also assessed. RESULTS: All three of the evaluated RDTs gave excellent performance with a combined sensitivity ranging from 99.0%-99.6% for HIV and 98.3%-99.0% for syphilis, and a combined specificity ranging from 97.9%-99.0% for HIV and 97.2%-99.6% for syphilis. Concordance of testing results between two technicians and stability of testing results read within and one hour past the recommended reading period showed excellent agreement, with Kappa greater than or equal to 0.98. CONCLUSIONS: All the tests were found to be very or fairly easy to use and easy to interpret the results. Further evaluations of these dual RDTs with whole blood in field settings, and more studies on the implication of introduction of these tests in HIV and syphilis control programs are needed.

Estimating disease burden of maternal syphilis and associated adverse pregnancy outcomes in India, Nigeria, and Zambia in 2012.

OBJECTIVE: To estimate maternal syphilis and its associated adverse pregnancy outcomes in India, Nigeria, and Zambia. METHODS: An online estimation tool was used to generate point estimates and uncertainty ranges of maternal syphilis and adverse pregnancy outcomes due to mother-to-child transmission (MTCT). The most recent data (2010-2012) on antenatal care coverage, syphilis seroprevalence, and syphilis screening and treatment coverage at the subnational level in India, Nigeria, and Zambia were used to estimate disease burden for 2012. Sensitivity analysis was conducted for three screening and treatment scenarios (current coverages, current coverages minus 20%, and ideal coverages consistent with WHO targets for eliminating MTCT of syphilis). RESULTS: A total of 103 960, 74 798, and 9072 pregnant women with probable active syphilis were estimated to occur in India, Nigeria, and Zambia, resulting in 53 187, 37 045, and 2973 adverse outcomes, respectively; approximately 1.6%, 4.8%, and 37.0% of these were averted under the current service coverages in India, Nigeria, and Zambia. The disease burden varied significantly in its subnational distribution within India and Nigeria, but was distributed evenly across Zambia. CONCLUSIONS: The obtained results suggest an ongoing, unaverted high burden of maternal syphilis and associated adverse outcomes in India, Nigeria, and Zambia. Screening and treatment for syphilis must be scaled-up significantly in these countries to achieve elimination of MTCT of syphilis.