As mpox cases surge once again in parts of Central Africa, the Democratic Republic of the Congo (DRC) is leading a bold, innovative strategy by integrating HIV and syphilis testing into its national mpox management framework. This approach, supported by the World Health Organization (WHO), represents a crucial advancement in public health aimed at addressing overlapping vulnerabilities and improving patient outcomes.
The integrated strategy is being spearheaded by the DRC’s Ministry of Health, with technical assistance from WHO. It aims to deliver comprehensive, person-centered care while reducing missed opportunities for diagnosis and treatment. Importantly, it also provides a more holistic response to sexually transmitted infections (STIs) by strengthening detection, treatment, and prevention across multiple diseases at once. Health professionals working on the frontlines in mpox treatment centers have voiced strong support for the initiative.
Mounting evidence underscores the urgent need for this integrated approach. People living with HIV—especially those who are undiagnosed or not virally suppressed—are at significantly higher risk for severe outcomes from mpox, including death. Additionally, cases of syphilis co-infection among mpox patients are increasingly being reported, particularly among key populations. Despite the availability of affordable and effective treatments, syphilis remains underdiagnosed and untreated in many low-resource settings. The disease has become the second leading cause of stillbirth globally, pointing to its broader implications for maternal and neonatal health.
“Increasingly, we’re seeing that individuals with HIV, particularly those with CD4 counts below 200 cells/mm³, are at risk of developing serious complications or dying from mpox,” said Dr. Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STI Programmes. “Timely access to HIV and syphilis testing and treatment, along with mpox vaccines and antivirals, is essential to save lives and prevent further transmission.”
Pilot Implementation in Kinshasa
The DRC became the first country to implement WHO’s Standard Operating Procedure (SOP) for integrating HIV and syphilis testing into mpox care in April 2025. The rollout began in Kinshasa, where health workers received WHO-supported training and began using dual rapid diagnostic tests for HIV and syphilis among patients suspected of having mpox.
Initially launched across five mpox treatment centers, the integrated testing approach now spans 11 health zones. Between April and June 7, 2025, the initiative produced promising results:
- 697 people with suspected mpox were tested for HIV and syphilis
- 36 individuals (5%) tested positive for HIV, including 27 with confirmed mpox co-infections
- 6 people (1%) tested positive for syphilis and received treatment on-site
- Weekly testing volumes climbed steadily, surpassing 120 tests per week
This early success has demonstrated the feasibility and public health value of combining disease surveillance and diagnostic services under a unified care model.
National Scale-Up and Strategic Coordination
Building on the Kinshasa pilot, national health authorities are now working to expand the integrated model across the country. On June 3, 2025, key partners—including the National HIV/AIDS Control Programme, WHO, the Ministry of Health, the Centre d’opérations d’urgence de santé publique (COUSP), and the Divisions provinciales de la santé (DPS)—convened to review implementation progress and chart a path for scale-up.
Priority actions identified during the meeting include:
- Drafting a therapeutic protocol for managing mpox/HIV co-infections
- Enhancing capacity at the Kinoise Mpox Treatment Centre
- Integrating mpox services into six established HIV care and treatment centers
- Improving coordination between health programs to reduce delays and optimize resource use
- Preparing for geographic expansion to provinces with high mpox transmission or high HIV prevalence
These efforts mark a significant step forward in aligning the country’s disease response infrastructure to tackle multiple epidemics simultaneously.
Confronting Operational Barriers
While the program has made meaningful progress, it has not been without challenges. Key logistical hurdles such as test kit stock-outs, expired HIV diagnostics, and delays in PCR test results for mpox have affected the continuity and timeliness of care. Furthermore, capacity to manage severe mpox and HIV co-infections remains limited. Currently, only one advanced care facility—run by Médecins Sans Frontières (MSF) in Kabinda, Kinshasa—is operational for such cases.
Despite these constraints, the DRC’s integrated model offers a promising framework for other countries in the region and beyond. By combining disease testing and care within a single service delivery platform, the initiative not only enhances patient outcomes but also strengthens health system resilience in the face of overlapping public health threats. As global health organizations continue to advocate for comprehensive care approaches, the DRC’s pioneering work could serve as a blueprint for future epidemic responses.
