As mpox cases rise again in parts of Central Africa, the Democratic Republic of the Congo is pioneering an integrated public health response for HIV and syphilis testing within national mpox management.
This integrated approach, led by the Ministry of Health with technical support from WHO, aims to provide comprehensive care, reduce missed opportunities for diagnosis and treatment and support community protection. Clinicians working at mpox testing sites have welcomed the initiative.
Growing evidence shows people with undiagnosed HIV and those living with HIV who are not virally suppressed are at increased risk of severe mpox illness and death. Co-infection with syphilis has also been documented among individuals affected by mpox, especially among key populations. Despite the availability of affordable and effective treatment, syphilis continues to be widely underdiagnosed and untreated, particularly in low-resource settings. It is now the second leading cause of stillbirth globally. Integrating syphilis screening into the mpox response not only addresses a major gap in maternal and newborn health but also reinforces broader efforts in surveillance, diagnosis and care of sexually transmitted infections (STIs).
“We now know people with HIV, particularly those with a CD4 count under 200 cells/mm³, are at risk for severe disease and death from mpox,” said Dr Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STI Programmes. “Ensuring early access to HIV and syphilis testing and treatment to all people with confirmed or suspected mpox, as well as timely access to mpox vaccines and antivirals, will save lives”.
Implementation in Kinshasa
In April 2025, the Democratic Republic of the Congo became the first country to implement WHO’s Standard Operating Procedure (SOP) for integrating HIV and syphilis testing services as part of the mpox response. With support from WHO, health workers were trained and began rolling out dual HIV/syphilis rapid diagnostic tests to improve detection among those with suspected mpox at designated treatment centres.
The approach was first launched in 5 mpox treatment centres and now covers 11 health zones. Between April 2025 and 7 June 2025:
- 697 individuals with suspected mpox were tested for HIV and syphilis;
- 36 (5%) tested positive for HIV, including 27 confirmed mpox co-infections;
- 6 individuals (1%) tested positive for syphilis and were treated on-site; and
- weekly testing volumes increased steadily, reaching over 120 tests per week.
National coordination and scale-up
This approach is now going national. On 3 June 2025, the National HIV/AIDS Control Programme, together with WHO, the Ministry of Health, the Centre d’opérations d’urgence de santé publique (COUSP), and the Divisions provinciales de la santé (DPS) reviewed progress and set priorities for expanding this integrated approach. Together, they have also:
- drafted a therapeutic protocol for managing HIV/mpox co-infection;
- strengthened capacity at the Kinoise Mpox Treatment Centre;
- integrated mpox services into 6 HIV care and treatment centres;
- strengthened inter-programme coordination to address delays and optimize limited resources; and
- prepared for geographic expansion to provinces with high mpox transmission and/or high HIV prevalence.
Addressing real world challenges
Despite strong progress, the rollout has faced logistical and operational challenges, including stock-outs, expiration of HIV test kits and delays in mpox PCR test results, which affect timely treatment. There has also been limited capacity to manage severe mpox/HIV co-infection, with only one advanced care site (MSF Kabinda in Kinshasa) in operation.
Looking ahead
As the country continues to confront multiple health threats, including mpox, HIV, and syphilis, its integrated testing model offers a blueprint for action in resource-limited settings. Lessons learned can be applied in other neighbouring countries as part of emergency and outbreak response, as well as for future preparedness and planning.
WHO and the Democratic Republic of the Congo are now planning to continue to provide joint supervision and mentoring visits, in order to strengthen data reporting and monitoring and improving stock management so as to avoid future commodity shortages. Both remain committed to protecting and saving lives by linking outbreak response with essential HIV and STI services, ensuring that no one is left behind.