HIV and syphilis testing at antenatal care in Lubumbashi, the Democratic Republic of the Congo: insights from public and private facilities

Abstract

Background

Among pregnant women, untreated HIV and syphilis may lead to vertical transmission, contributing to adverse maternal and perinatal outcomes. Integrating HIV and syphilis testing into antenatal care (ANC) – a near universally-used service – is crucial for reducing transmission. However, little is known on the integration of HIV and syphilis testing into ANC in the Democratic Republic of Congo. This study explores HIV and syphilis testing service delivery through ANC by describing testing provision per ANC visit across healthcare facilities in Lubumbashi.

Methods

Between July 29 and December 1, 2024, data were collected from 187 of the largest maternal healthcare facilities providing ANC across all 11 health zones in Lubumbashi. Data on weekly number of ANC visits and HIV and syphilis tests conducted were collected from registers. Testing coverage was calculated as the percentage of ANC visits with HIV or syphilis testing and described per healthcare facility characteristics, including sector, level of care, and health zone.

Results

Over half of the 187 healthcare facilities were in Lubumbashi (29.4%; 55/187), Mumbunda (14.4%; 27/187), and Kampemba health zones (14.4%; 27/187). Most were private (86.6%; 162/187); 64.2% (120/187) were primary-level healthcare facilities. During the study period, 28,146 ANC visits, 13,725 HIV and 7,164 syphilis tests were recorded. Overall, the coverage of HIV testing was 48.8% and of syphilis was 25.5%. Public (56.5%; 2,249/3,979) and private-for-profit (51.5%; 8,165/15,861) healthcare facilities had a higher HIV testing coverage compared to private-non-profit (39.9%; 3,311/8,306) facilities. Syphilis testing coverage was highest in private-for-profit (30.4%; 4,823/15,861) healthcare facilities compared to public (18.7%, 746/3,979) and private-non-profit (19.2%; 1,595/8,306) facilities. HIV testing coverage was similar between higher-level (49.6%; 4,831/9,742) and primary-level healthcare facilities (48.3%; 8,894/18,404), while for syphilis coverage was 33.1% (3,229/9,742) in higher-level compared to 21.4% (3,935/18,404) in primary-level healthcare facilities. Tsamilemba health zone recorded the highest HIV coverage (82.4%; 3,177/3,854), Kenya health zone led syphilis (71.2%; 1,030/1,446).

Conclusions

This study highlights that syphilis testing coverage lags behind HIV testing across healthcare sectors, facility levels, and health zones. Promoting broader adoption of dual HIV/syphilis rapid diagnostic tests will be critical to improve testing access and enhance maternal and perinatal health outcomes.