Quality assurance for RPR testing in first antenatal attendees

Reported here are findings of the RPR results tested by nurses and laboratory technicians. The involvement of nurses in testing for RPR was aimed at increasing the coverage for women attending antenatal clinics during the outreach programs. There were no laboratory facilities in such places beside the long distances. Nurses in these outreach programs did not use basic equipment such as shakers and centrifuges.
A total of 990 samples were screened of which nurses did 493 and the other 497 were done by laboratory technicians. Both nurses and laboratory technicians reported some amount of false positive results, 11/58 (18.9%) and 9/47 (20%) respectively. Total positive from all the sites was found to be 10.8% (106/990), while upon retesting using the same test (RPR) was 9.7%. Later on TPHA confirmatory test revealed 8.9% (88/990). Even though statistically the difference is minimal, the fact cannot be ignored that there is some discrepancy in the level of training between the nurses, laboratory technician and those at the reference laboratory.This study also shows that not using basic equipment such as a shaker and a centrifuge did not affect the result.False positive results, which may be technical or biological, may be not infrequently encountered when tests employing non-treponema antigens are used. Thus an initiaJ positive result may not necessarily mean that the client has a syphilis infection before confirmation with specific tests such as TPHA.With such high prevalence of reactive syphilis (8.9% confirmed), screening should be aimed a covering/reaching out to all pregnant women to avoid the adverse outcome of undetectable and untreated syphilis such as congenital syphilis. If all women attended ANC the real picture of RPR positivity and negativity could be estimated. In order to ensure quality of RPR test, random TPHA needs to be done. If the difference in the accuracy of RPR tests between the nurses and laboratory technicians is more, then there is need to carry out training program to strengthen their ability.