Catch syphilis before it reaches the baby.
Women already come to antenatal clinics and are already tested for HIV. Swapping in a test that checks for both, and stocking the penicillin that treats it, is most of the work.
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Syphilis is a bacterial infection that passes from a pregnant woman to her baby. Left untreated it causes stillbirth, newborn death and lifelong disability in a large share of cases. A rapid test at a routine antenatal visit finds it, and an injection of benzathine penicillin, given in time, prevents almost all of that harm.
- SyphilisWorld Health OrganizationThe fact sheet, including what untreated syphilis in pregnancy does to the baby.
- SyphilisWorld Health OrganizationWHO's programme page on eliminating mother-to-child transmission.
- Syphilis screening and treatment in pregnancyGiveWellGiveWell's report on the intervention: the evidence, the cost, and the open questions.
No published cost per woman screened, so the tiers describe the work rather than a price per test.
The figures
What Evidence Action's syphilis screening program does
Evidence Action advises the health ministries of Zambia and Cameroon on switching antenatal clinics from HIV-only rapid tests to dual HIV and syphilis tests, and on keeping benzathine penicillin in stock so that a positive result is actually treated. It is technical assistance to a system that already exists, not a parallel clinic.
How GiveWell gets there
Treating syphilis in pregnancy with benzathine penicillin has good evidence behind it for reducing stillbirth, newborn death, preterm birth and congenital syphilis. GiveWell models how many additional women get tested and treated because of the switch, and what that prevents.
What could be wrong
- GiveWell assigns 33 quality-adjusted life years to a stillbirth averted, and says plainly that the moral weight of a stillbirth is highly uncertain. A large share of this program's estimated value rests on that judgment, and you may weigh it differently.
- The 29x figure is high partly because the marginal cost is small: the clinics, the visits and the HIV test already exist. That is a real advantage, and it also means the estimate depends on the existing system continuing to work.
- This is a grantee, not a Top Charity, and the grant runs to a fixed end date rather than being an open-ended recommendation.
- There is no published cost per woman screened, so we do not quote one. The tiers above describe the work, not a unit price.
Every figure is an average program cost, not a receipt. How we phrase things.