Assessing the Adoption of Dual HIV/Syphilis Rapid Diagnostic Tests in Eastern Cape Antenatal Clinics to Mitigate Congenital Syphilis: A 2003 Survey Analysis

Congenital syphilis persists as a major public health burden in South Africa. The integration of dual HIV/syphilis rapid diagnostic tests (RDTs) into antenatal care offers a strategic opportunity to enhance screening and prevent mother-to-child transmission. The Eastern Cape province, with a high prevalence of both infections, is a priority setting for this intervention. This survey aimed to assess the adoption and utilisation of dual HIV/syphilis RDTs in Eastern Cape antenatal clinics. It sought to identify the key barriers and facilitators to implementation from the perspective of healthcare providers. A cross-sectional survey was conducted among healthcare providers in public-sector antenatal clinics across the Eastern Cape. A structured questionnaire was administered to a purposive sample of nurses and clinic managers, collecting data on test availability, staff training, usage protocols, and perceived challenges. Descriptive statistics and thematic analysis were employed. Adoption of the dual test was inconsistent. While most surveyed clinics reported having the tests available, less than half utilised them as the primary screening tool. Key barriers included sporadic stock-outs, insufficient training on the dual-test platform, and a stated preference for established, separate testing algorithms. The potential of dual HIV/syphilis RDTs to reduce congenital syphilis is not being fully realised in the Eastern Cape due to suboptimal implementation. Systemic health system challenges substantially hinder effective adoption. To improve adoption, targeted interventions should include: strengthening supply chain management for test kits, implementing standardised training programmes for healthcare workers on dual-test use, and revising clinical guidelines to promote the dual-test algorithm. congenital syphilis, dual rapid diagnostic test, antenatal screening, implementation science, health systems, South Africa This survey provides a situational analysis of dual HIV/syphilis RDT adoption in a high-prevalence province, identifying specific, modifiable health system barriers that must be addressed to translate policy into effective practice.