Missiani Ochwoto ^1* Micah Matiang'i ^2,3 Noah Machuki ⁴ Simon Ndoria ² Lydia Matoke ⁵ Maureen Atinga ⁴ Catherine Ngondo ⁶ Jeremiah Zablon ⁷ Evans Mathebula ^8,9 Damaris Matoke-Muhia ⁴

• ¹ 1. Innovation Technology Transfer Division, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
• ² Amref Health Africa, Nairobi, Kenya
• ³ School of Medical Sciences, Amref International University, Nairobi, Kenya
• ⁴ Centre for Biotechnology Research and Development, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
• ⁵ Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
• ⁶ Rapid Diagnostics of Infectious Diseases, Abbott Kenya,, Nairobi, Kenya
• ⁷ Department of Pathology and Laboratory Medicine, Division of Biology and Medicine, Brown University, Providence, United States
• ⁸ Abbott Rapid Diagnostics, Abbott, Johannesburg, South Africa
• ⁹ School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

Contracting HIV, Syphilis, Hepatitis B virus (HBV) and Malaria infections during pregnancy affect the health of the woman, the pregnancy and the unborn child. World Health Organization (WHO) recommends testing pregnant women for these infections for triple elimination of mother-to-child transmissions. However, this is not fully realized in low-medium income countries mainly because of segmented testing. Here, we aimed to investigate the effect of introducing a 4-test ANC testing panel on the quality of antenatal care among pregnant women in selected health facilities in Kenya. Using a multi-design approach, ANC medical records from 577 pregnant women from eight facilities in four different counties showed that only 8.3% had undergone tests for all four infections. Most of the mothers had tested for syphilis (93.7%), HIV (78.5%), Malaria (62.6%) and only 19.5% for HBV. Testing the women using the 4 test ANC panel led to a positivity rate of 6.9% for HIV, 0.9% for syphilis, 1.9% for malaria and 1.1% for HBV. Among those without previous test results, the positivity rate was 2.8% in syphilis, 13.8% for HIV of which 10.6% were positive for p24 recent infections (F = 24.876, p < 0.001), 2.3% for malaria and 4.5% for HBV where 83.3% had no previous test results. The mean of those tested using the 4 ANC panel compared to segmented single tests was significantly different. The panel was cost-effective, user friendly to health care workers, and in facilities with staff shortage it reduced turnaround time and workloads by half. Testing using the panel improved the ANC mother profiling and data management of the four infections by 91.7%. Therefore, embracing the use of the 4 ANC panel has the potential to improve test result outputs, quality-of-service delivery, and progress a country towards achieving the triple elimination goals.