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Table 2 Thematic framework, personnel interviewed and key findings of investigation of syphilis POC testing policy in Ghana

From: Rollout of rapid point of care tests for antenatal syphilis screening in Ghana: healthcare provider perspectives and experiences

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
  1. ANC - Antenatal care; POCT – Point of care test; STI - Sexually transmitted infection