CHAI has released the inaugural edition of its Triple Elimination Series, a set of market briefs examining market-shaping strategies to prevent vertical transmission of HIV, syphilis, and hepatitis B (commonly known as triple elimination). This first brief focuses on the introduction and scale-up of HIV/syphilis dual rapid diagnostic tests (RDTs), drawing on CHAI’s experience working with governments and partners across six countries.
The challenge
Each year, vertical transmission of HIV and syphilis causes significant but preventable infant morbidity, mortality, and stillbirths—particularly in sub-Saharan Africa.
Syphilis alone remains a leading cause of stillbirths, with congenital cases rising globally.
While HIV testing coverage among pregnant women has steadily improved since 2015, syphilis screening remains inconsistent, limiting timely access to care.
Ten years of lessons
The brief outlines how scale-up of dual RDTs took nearly a decade, with progress varying widely across countries. Adoption depended on multiple enabling actions—from policy updates and product readiness to financing and implementation—which gradually converged to support uptake. A timeline in the brief highlights how milestones such as WHO’s 2017 informational note catalyzed policy change, procurement, and rollout. Drawing on six CHAI-supported countries, the analysis distills key insights on what drove adoption and efficiency gains.
Impact to date
All six countries updated national guidelines to enable dual RDT adoption, often alongside pilots and algorithm revisions.
Prioritization in Global Fund, PEPFAR, and national budgets helped accelerate uptake, supported by integrated planning, training, and data system updates.
By 2023–24, syphilis testing coverage nearly matched HIV coverage across all six countries, with three surpassing 90 percent for both. Countries also reported efficiency gains for patients, providers, and health systems.
Looking forward
Understanding the enablers of dual RDT scale-up provides a blueprint for future multiplex diagnostics, including HIV/syphilis/hepatitis B “triple tests”. Early investments in policy alignment, market shaping, and financing can help countries avoid long delays between product availability and uptake. Applying these lessons are important to advance integrated testing strategies, strengthen triple elimination efforts, and sustain progress even amid tightening budgets and shifting priorities.
