[Educating health workers is key in congenital syphilis elimination in Colombia].

INTRODUCTION: Colombia promotes the diagnosis and treatment of gestational syphilis in a single visit using rapid diagnostic tests to prevent mother-to-child transmission. Additionally, integrated health programs pursue the coordinated prevention of mother-to-child transmission of syphilis/HIV. OBJECTIVE: To identify knowledge gaps among health workers in the prevention of mother-to-child transmission of syphilis/HIV and to provide recommendations to support these programs. MATERIALS AND METHODS: We conducted a descriptive study based on 306 surveys of health workers in 39 health institutions in the city of Cali. Surveys inquired about planning, management and implementation of services for pregnant women, clinical knowledge of HIV/syphilis rapid diagnostic tests, and prior training. RESULTS: Knowledge deficits in the management of gestational syphilis were detected among the surveyed health workers, including physicians. Rapid tests for syphilis are currently used in clinical laboratories in Cali, however, procedural deficiencies were observed in their use, including quality control assurance. During the two years prior to the survey, training of health workers in the prevention of mother-to-child transmission of syphilis/HIV had been limited. Health workers are interested in identifying and treating gestational syphilis in a single event, in using rapid diagnostic tests and in receiving training. CONCLUSIONS: Intensive training targeting health workers, policy/decision makers and academic groups is needed to ensure adequate implementation of new strategies for the prevention of mother-to-child transmission of syphilis/HIV.

La educación del personal de salud: clave para la eliminación de la sífilis congénita en Colombia / Educating health workers is key in congenital syphilis elimination in Colombia

Resumen Introducción. Para la prevención de la transmisión materno-infantil de la sífilis en Colombia, se promueve el diagnóstico y el tratamiento en una sola consulta mediante el uso de pruebas de diagnóstico rápido, así como programas de eliminación conjunta de la transmisión materno-infantil de la sífilis y el HIV. Objetivo. Detectar los vacíos de capacitación del personal de salud en torno a la prevención de la transmisión materno-infantil de la sífilis y el HIV, y hacer recomendaciones para mejorar los programas. Materiales y métodos. Se hizo un estudio descriptivo mediante 306 encuestas hechas al personal de salud de 39 instituciones de Cali. Se indagó sobre la planeación, la gestión y la ejecución de los servicios ofrecidos a las mujeres gestantes, los conocimientos clínicos sobre la sífilis, el HIV y las pruebas rápidas, así como sobre las capacitaciones recibidas. Resultados. Se encontraron deficiencias en el conocimiento del manejo de la sífilis gestacional entre el personal de salud, incluidos los médicos. Las pruebas de diagnóstico rápido para sífilis se utilizan en los laboratorios de la ciudad, pero se detectaron fallas en su uso adecuado, especialmente en el control de calidad. La capacitación en temas de prevención de la transmisión materno-infantil de la sífilis y el HIV había sido escasa en los dos años anteriores. El personal de salud expresó su interés por diagnosticar y tratar la sífilis gestacional en una sola consulta, usar las pruebas de diagnóstico rápido y asistir a actividades de capacitación. Conclusiones. Se requiere la capacitación intensiva del personal de salud, de quienes toman las decisiones y de los grupos académicos, para lograr una adecuada implementación de las nuevas estrategias de prevención de la transmisión materno-infantil de la sífilisy el HIV.

Abstract Introduction: Colombia promotes the diagnosis and treatment of gestational syphilis in a single visit using rapid diagnostic tests to prevent mother-to-child transmission. Additionally, integrated health programs pursue the coordinated prevention of mother-to-child transmission of syphilis/HIV. Objective: To identify knowledge gaps among health workers in the prevention of mother-to-child transmission of syphilis/HIV and to provide recommendations to support these programs. Materials and methods: We conducted a descriptive study based on 306 surveys of health workers in 39 health institutions in the city of Cali. Surveys inquired about planning, management and implementation of services for pregnant women, clinical knowledge of HIV/syphilis rapid diagnostic tests, and prior training. Results: Knowledge deficits in the management of gestational syphilis were detected among the surveyed health workers, including physicians. Rapid tests for syphilis are currently used in clinical laboratories in Cali, however, procedural deficiencies were observed in their use, including quality control assurance. During the two years prior to the survey, training of health workers in the prevention of mother-to-child transmission of syphilis/HIV had been limited. Health workers are interested in identifying and treating gestational syphilis in a single event, in using rapid diagnostic tests and in receiving training. Conclusions: Intensive training targeting health workers, policy/decision makers and academic groups is needed to ensure adequate implementation of new strategies for the prevention of mother-to-child transmission of syphilis/HIV.

[Initial drug resistance as a threat for tuberculosis control: the case of Buenaventura, Colombia]. / Resistencia inicial a drogas antituberculosas en Buenaventura, Colombia.

In 2001, Buenaventura, Colombia, the rate of smear-positive pulmonary tuberculosis was of 66 per 100,000 inhabitants. The poor control of the tuberculosis in this city during the last 10 years and the inadequate use of first-line anti-tuberculosis drugs was an opportune situation for the development of high resistance to these drugs. Two surveys of initial resistance to first-line antituberculosis drugs were conducted in new cases of pulmonary TB, in the city of Buenaventura--the first from August 1, of 1997 to January 31 of 1998 and the second from November 15, of 2000 to November 15, 2001. The method of multiple proportions was used to determine drug susceptibility. Mycobacterium tuberculosis was isolated in 93% and 55% of the new cases of lung TB during each respective period. The initial resistance to at least one drug was 25% (9/36) and 32% (23/72), respectively. The initial multi-drug resistance (defined as resistance to at least isoniazid and rifampicin) was 6% for both surveys. This demonstrates the dissemination of multidrug-resistant bacilli and shows the need for surveillance of resistance to antituberculosis drugs in control of the disease, particularly in those areas where the TB control program has been erratically applied. In areas where multi-drug resistant TB occurs, the control strategy should be enhanced with the careful introduction of second-line drugs.

Resistencia inicial a drogas antituberculosas en Buenaventura, Colombia

La tasa de notificación de tuberculosis pulmonar bacilífera en 2001 en Buenaventura, Colombia, fue de 66 por 100.000 habitantes. El pobre control de la tuberculosis en este municipio durante los últimos 10 años y el uso inadecuado de medicamentos de primera línea hace sospechar una elevada resistencia a estas drogas antituberculosas. En este artículo se presentan y discuten los resultados de dos encuestas de resistencia inicial a drogas antituberculosas de primera línea en personas con tuberculosis pulmonar realizadas en Buenaventura entre el 1° de agosto de 1997 y el 31 de enero de 1998, y entre el 15 de noviembre de 2000 y el 15 de noviembre de 2001, con un intervalo de dos años y nueve meses. En las dos encuestas se utilizó el método de proporciones múltiples. Se logró aislar Mycobacterium tuberculosis en 93% y 55% de los casos nuevos de tuberculosis pulmonar diagnosticados en cada uno de los periodos estudiados. La resistencia inicial a cualquier medicamento antituberculoso fue de 25% (9/36) y 32% (23/72) en la primera y segunda encuesta, respectivamente. La multirresistencia inicial (definida como resistencia, al menos, a isoniacida y rifampicina) fue de 6% en ambas encuestas. Este porcentaje de resistencia encontrado demuestra la diseminación de cepas multirresistentes y destaca a la vigilancia epidemiológica de la resistencia a drogas antituberculosas como un componente esencial en el control de la enfermedad, por lo menos, en las zonas en las que el programa ha sido errático en el pasado. De esta manera, se podrán identificar las áreas en las que la estrategia DOTS deba ser reforzada con el uso de drogas de segunda línea (DOTS-plus).

In 2001, Buenaventura, Colombia, the rate of smear-positive pulmonary tuberculosis was of 66 per 100.000 inhabitants. The poor control of the tuberculosis in this city during the last 10 years and the inadequate use of first-line anti-tuberculosis drugs was an opportune situation for the development of high resistance to these drugs. Two surveys of initial resistance to first-line antituberculosis drugs were conducted in new cases of pulmonary TB, in the city of Buenaventura-the first from August 1, of 1997 to January 31 of 1998 and the second from November 15, of 2000 to November 15, 2001. The method of multiple proportions was used to determine drug susceptibility. Mycobacterium tuberculosis was isolated in 93% and 55% of the new cases of lung TB during each respective period. The initial resistance to at least one drug was 25% (9/ 36) and 32% (23/72), respectively. The initial multi-drug resistance (defined as resistance to at least isoniazid and rifampicin) was 6% for both surveys. This demonstrates the dissemination of multidrug-resistant bacilli and shows the need for surveillance of resistance to antituberculosis drugs in control of the disease, particularly in those areas where the TB control program has been erratically applied. In areas where multi-drug resistant TB occurs, the control strategy should be enhanced with the careful introduction of second-line drugs.