Audit of Antenatal Screening for Syphilis & HIV in Migrant & Refugee Women on the Thai-Myanmar Border: A Descriptive Study

OBJECTIVE:

The antenatal prevalence of syphilis and HIV/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in the same population and reassess the trends in HIV rates.

METHODS:

From August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border.

RESULTS:

Seroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13/2,123). The three active (VDRL≥1:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (>75% were < 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors.

CONCLUSION:

As HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies.

Table 2.

Trends in antenatal HIV and syphilis prevalence (95% CI) in migrant and refugee women at SMRU from surrounding areas of Thailand and Myanmar.

	Population	1997 Cross-sectional	2005 Cross-sectional	Aug-2012–Jul-2013 Population cohort
Syphilis	Refugee a, b	0 (0–0.9)% (0/404)	0.40 (0.1–1.2)% (3/741)	0.07 (0.01–0.38)% (1/1,469)
	Migrant a, b	n.a	0 (0–1.6) (0/234)	0.61 (0.36–1.04)% (13/2,123)
	Thailand c	n.a	0.13%	0.1%
	Myanmar c	n.a.	2.0%	0.32 (0.24–0.43)% (45/13,995)
	Myawaddy c			0.50 (0.14–0.18)% (2/400)
HIV	Refugee b	0.2 (0–1.1)% (0/500)	0.40 (0.1–1.4)% (2/500)	0.27 (0.11–0.70)% (4/1,474)
	Migrant b	n.a	n.a.	0.61 (0.36–1.04)% (13/2,125)
	Thailand c	1.75%	0.86%	0.59%
	Myanmar c	1.5%	1.3%	0.80 (0.67–0.96)% (112/13995)
	Myawaddy c			1.5 (0.39–2.54)% (4/400)

aSerological syphilis positive using the same criteria, and the same hospital for confirmatory testing at each survey time point; n.a. not available

bData from refugee and migrant populations in 1997 and 2005; published in reference 7

cData for Thailand from reference 21 and Myanmar from reference 22

Full article at:   http://goo.gl/3Vgteu

By:   McGready R1, Kang J2, Watts I2, Tyrosvoutis ME2, Torchinsky MB2, Htut AM2, Tun NW2, Keereecharoen L2, Wangsing C2, Hanboonkunupakarn B3, Nosten FH1.

• 1Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand ; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand ; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK.
• 2Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.
• 3Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand. 

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