(P331) Dual tests HIV/Syphilis usability and acceptance in Brazil: strategy for expanding prenatal syphilis screening

Background: Brazil has advanced in the prevention of mother-to-child transmission of HIV, with current rates close to elimination. However, congenital syphilis has increased around 3 times in the last decade, constituting a serious national public health problem. This discrepancy occurs even with rapid tests available for the two diseases in health units since 2005. World Health Organization recommends dual testes (DT) to increase testing offers due to simultaneous anti-HIV and treponemal antibodies detection. Ministry of Health led a pilot project to evaluate DT usability and acceptance by public health professionals as a first step to subsidize a future implementation.

Methods: 15 cities from all 5 Brazilian regions were included. Virtual training and a technical note with recommendations for DT execution and use in diagnostic algorithms (Figure 1) were provided. An online, anonymous questionnaire, consisting of 9 single-answer, 5 open-answer, 3 multiple-choice and 2 dichotomous, was applied in July 2022 to evaluate DT performer's perception of test use and educational material.

Results: 37 answers were received from 12/15 cities. 79% performed online training and 82% accessed the technical note. Half of the respondents followed the recommendation using DT as the first test in the diagnostic algorithm, and the other half used DT in disagreement with the guidance. Only 5% reported difficulties using the lancet or interpreting the instructional material. 74% reported a preference for DT over single rapid tests, 5% preferred single rapid tests and 21% had no preference. DT main advantages related were: only one digital puncture was needed to simultaneously test both infections, storage capacity optimization and service time reduction.

Conclusions: DT can be a strategy for coping with congenital syphilis in Brazil, as a tool to expand prenatal syphilis testing. The study shows high DT acceptance and easiness to use. DT was considered advantageous by professionals compared to single rapid tests. DT use in different algorithms than those recommended for single rapid tests show the need to review educational materials such as finding new strategies to ensure access and effective training. The results can subsidize DT incorporation in Brazilian public health system and economic feasibility studies are necessary.