CDC Foundation, Atlanta, Georgia, USA.
World Health Organization, Geneva, Switzerland.
J Glob Health. 2020 Jun;10(1):010504. doi: 10.7189/jogh.10.010504.
Countdown to 2030 (CD2030) tracks progress in the 81 countries that account for more than 90% of under-five child deaths and 95% of maternal deaths in the world. In 2017, CD2030 identified syphilis screening and treatment during antenatal care (ANC) as priority indicators for monitoring.
Country-reported data in the UNAIDS Global AIDS Monitoring System (GAM) system were used to evaluate four key syphilis indicators from CD2030 countries: (1) maternal syphilis screening and (2) treatment coverage during ANC, (3) syphilis seroprevalence among ANC attendees, and (4) national congenital syphilis (CS) case rates. A cascade analysis for CD2030 countries with coverage data for the number of women attending at least 4 antenatal care visits (ANC4), syphilis testing, seroprevalence and treatment was performed to estimate the number of CS cases that were attributable to missed opportunities for syphilis screening and treatment during antenatal care.
Of 81 countries, 52 (64%) reported one or more values for CS indicators into the GAM system during 2016-2017; only 53 (65%) had maternal syphilis testing coverage, 41 (51%) had screening positivity, and 40 (49%) had treatment coverage. CS case rates were reported by 13 (16%) countries. During 2016-2017, four countries reported syphilis screening and treatment coverage of ≥95% consistent with World Health Organization (WHO) targets. Sufficient data were available for 40 (49%) of countries to construct a cascade for data years 2016 and 2017. Syphilis screening and treatment service gaps within ANC4 resulted in an estimated total of 103 648 adverse birth outcomes with 41 858 of these occurring as stillbirths among women attending ANC4 (n = 31 914 408). Women not in ANC4 (n = 25 619 784) contributed an additional 67 348 estimated adverse birth outcomes with 27 198 of these occurring as stillbirths for a total of 69 056 preventable stillbirths attributable to syphilis in these 40 countries.
These data and findings can serve as an initial baseline evaluation of antenatal syphilis surveillance and service coverage and can be used to guide improvement of delivery and monitoring of syphilis screening and treatment in ANC for these priority countries.
倒计时 2030 年（CD2030）跟踪了占世界五岁以下儿童死亡人数 90%以上和孕产妇死亡人数 95%以上的 81 个国家的进展情况。2017 年，倒计时 2030 年确定了在产前护理期间进行梅毒筛查和治疗作为监测的优先指标。
利用艾滋病署全球艾滋病监测系统（GAM）中的国家报告数据，评估来自倒计时 2030 年国家的四个关键梅毒指标：（1）孕产妇梅毒筛查和（2）产前护理期间的治疗覆盖率、（3）产前保健就诊者中的梅毒血清阳性率和（4）国家先天梅毒（CS）病例率。对有数据的 CD2030 国家进行级联分析，这些数据包括接受至少 4 次产前保健就诊的妇女人数、梅毒检测、血清阳性率和治疗情况，以估计因产前保健期间梅毒筛查和治疗机会错失而导致的 CS 病例数。
在 81 个国家中，有 52 个（64%）国家在 2016-2017 年期间向 GAM 系统报告了一个或多个 CS 指标值；只有 53 个（65%）国家报告了孕产妇梅毒检测覆盖率，41 个（51%）国家报告了筛查阳性率，40 个（49%）国家报告了治疗覆盖率。有 13 个（16%）国家报告了 CS 病例率。2016-2017 年期间，有四个国家报告的梅毒筛查和治疗覆盖率达到了世卫组织（WHO）目标的 95%以上。有 40 个（49%）国家有足够的数据可用于构建 2016 年和 2017 年的数据级联。在接受 ANC4 的妇女中，产前护理 4 次时梅毒筛查和治疗服务的差距导致了总共 103648 例不良生育结局，其中 41858 例为死产（ANC4 就诊人数为 31914408）。不在 ANC4 就诊的妇女（n=25619784）又导致了另外 67348 例估计的不良生育结局，其中 27198 例为死产，因此，这 40 个国家共有 69056 例可预防的死产归因于梅毒。
这些数据和结果可以作为产前梅毒监测和服务覆盖的初步基线评估，并可用于指导这些优先国家改进提供服务和监测 ANC 中的梅毒筛查和治疗。
