Abstract:
INTRODUCTION: Contracting HIV, syphilis, hepatitis B virus (HBV), and malaria
during pregnancy significantly affects the health of the woman, the pregnancy,
and the unborn child. The World Health Organization (WHO) recommends
testing pregnant women for these infections to achieve triple elimination of
mother-to-child transmissions. However, this goal has not been fully realized
in low- to medium-income countries, primarily due to segmented testing
practices. This study aimed to investigate the effect of introducing a four-tests
panel on the quality of antenatal care (ANC) among pregnant women attending
selected Primary Health Care facilities in Kenya.
METHODS: Using a multi-design approach, we analyzed ANC medical records
from 577 pregnant women attending eight facilities across four different
counties. Blood from the women fingerpick was tested for HIV, Syphilis Hepatitis
B Virus and Malaria using the four-tests panel and the results compared to those
in the medical records.
RESULTS: Out of 577 ANC women, only 8.3% had test results for all four infections
available. The majority of the mothers had been tested for syphilis (93.7%), HIV
(78.5%), and malaria (62.6%), only 19.5% had been tested for HBV. Testing the women
using the 4-tests panel yielded positivity rates of 6.9% for HIV, 0.9% for syphilis, 1.9%
for malaria, and 1.1% for HBV. Among those without previous test results, the positivity
rate was 2.8% for syphilis, 13.8% for HIV (with 10.6% testing positive for recent p24
infections, F = 24.876, p < 0.001), 2.3% for malaria, and 4.5% for HBV, with 83.3%
of these individuals having no prior test results. The mean positivity rate of those
tested using the 4-tests panel compared to segmented single tests was significantly
different. The panel was cost-effective and user-friendly for healthcare workers, and
in facilities facing staff shortages, it reduced turnaround time and workloads by half.
The use of the panel also improved the profiling of ANC mothers and enhanced data
management for the four infections by 91.7%.
CONCLUSION: Adopting the 4-tests panel has the potential to improve test result
outputs, enhance the quality-of-service delivery, and contribute significantly to
the achievement of triple elimination goals.
