Objectives. This study sought to assess the performance, effectiveness, and
costs of a decentralized antenatal syphilis screening prograrn in Nairobi,
Kenya.
Methods. Health clinic data, quality control data, and costs were analyzed.
Results. The rapid plasma reagin (RPR) seroprevalence was 3.4%. In terms of
screening, treatment, and partner notification, the program's performance
was adequate. The program's effectiveness was problematic because of false-
negative and false-positive RPR results. The cost per averted case was calc
ulated to be US $95 to US $112.
Conclusions. The sustainability of this labor-intensive program is threaten
ed by costs and logistic constraints. Alternative strategies, such as the m
ass epidemiologic treatment of pregnant women iii high-prevalence areas, sh
ould be considered.