Evaluation of Rapid Syphilis Testing Using the Syphilis Health Check in Florida, 2015-2016.

Florida public health review Pub Date : 2019-01-01 Epub Date: 2019-11-08
Jennifer Richards, James Matthias, Charlotte Baker, Craig Wilson, Thomas A Peterman, C Perry Brown, Matthew Dutton, Yussif Dokurugu
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Abstract

The Syphilis Health Check (SHC) had low estimated specificity (91.5%) in one Florida county. We investigated use of SHC by a range of Florida publicly-funded programs between 2015 and 2016 to estimate specificity, positive predictive value (PPV), field staff acceptance, and impacts on programmatic outcomes. All reported SHC results were extracted from routinely collected program data. Field staff were surveyed about SHC's utility. Analyses investigated differences between SHC and traditional syphilis testing outcomes. Of 3,630 SHC results reported, 442 were reactive; 92 (20.8%) had prior diagnoses of syphilis; 7 (1.6%) had no further testing. Of the remaining 343; 158 (46.0%) were confirmed cases, 168 (49.0%) were considered false-positive, and 17 (5.0%) were not cases but not clearly false-positive. Estimated specificity of SHC was 95.0%. Overall, 48.5% of positives became confirmed cases (PPV). PPV varied according to prevalence of syphilis in populations tested. Staff (90%) thought SHC helped identify new cases but expressed concern regarding discordance between reactive SHC and lab-based testing. Programmatic outcomes assessment showed shorter time to treatment and increased numbers of partners tested for the SHC group; these enhanced outcomes may better mitigate the spread of syphilis compared to traditional syphilis testing alone, but more research is needed.

2015-2016年佛罗里达州梅毒健康检查快速梅毒检测效果评价
在佛罗里达州的一个县,梅毒健康检查(SHC)的估计特异性较低(91.5%)。我们调查了2015年至2016年期间佛罗里达州一系列公共资助项目中SHC的使用情况,以估计特异性、阳性预测值(PPV)、现场工作人员接受度以及对项目结果的影响。所有报告的SHC结果都是从常规收集的项目数据中提取的。对现场工作人员进行了关于SHC效用的调查。分析调查了SHC和传统梅毒检测结果之间的差异。在报告的3630例SHC结果中,442例是反应性的;92例(20.8%)既往有梅毒诊断;7例(1.6%)未作进一步检测。在剩下的343人中;确诊158例(46.0%),假阳性168例(49.0%),未确诊但假阳性不明显的17例(5.0%)。估计SHC的特异性为95.0%。总体而言,48.5%的阳性病例成为确诊病例(PPV)。PPV根据测试人群中梅毒的流行程度而变化。工作人员(90%)认为SHC有助于识别新病例,但对反应性SHC和实验室检测之间的不一致表示担忧。规划结果评估显示,SHC组治疗时间缩短,接受检测的伴侣数量增加;与传统的梅毒检测相比,这些增强的结果可能更好地减轻梅毒的传播,但需要更多的研究。
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