Implementing Care for Pregnant Women with Syphilis: Perspectives of Primary Health Care Workers
1
University of São Paulo Medical School, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A2330
ABSTRACT
BACKGROUND:
Congenital and gestational syphilis remain major public health challenges and a marker of avoidable inequities. In 2022, the World Health Organization estimated 700000 congenital syphilis cases globally, including 150000 early fetal deaths/stillbirths and 70000 neonatal deaths. In Brazil, despite national initiatives (e.g., the Rapid Response to Syphilis in Health Care Networks), the burden persists. In 2024, 89724 cases of syphilis in pregnancy were reported and 24443 congenital syphilis cases were notified (incidence 9.6 per 1000 live births). This study explored primary health care workers perceptions of barriers and facilitators to caring for pregnant women with syphilis.
METHODS:
Qualitative study with semi-structured interviews of 27 primary health care workers in the city of São Paulo, the most populated city in Latin America. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. Themes were mapped to domains and constructs of the Consolidated Framework for Implementation Research (CFIR, 2020 version).
RESULTS:
Barriers clustered across CFIR domains: (I) Inner setting: religious influences, stigma related to sexually transmitted infections and insufficient consultation time; (II) Outer setting: structural machismo and ineffective intersectoral coordination; (III) Individuals: regarding the workers, limited prioritization of syphilis care and gaps in technical training and cultural competence; among women, low level of education. Facilitators included coordination with urgent care units, from outer setting; interprofessional collaboration, active outreach to reduce missed appointments, and flexible scheduling, from Process.
CONCLUSIONS:
Improving this women health care requires equity-oriented, culturally inclusive, and sustainable implementation strategies: strengthen communication to address stigma and gender power dynamics, expand competency-based training, and redesign care pathways and intersectoral integration to ensure timely testing, treatment, partner management, and longitudinal follow-up within primary health care.
Congenital and gestational syphilis remain major public health challenges and a marker of avoidable inequities. In 2022, the World Health Organization estimated 700000 congenital syphilis cases globally, including 150000 early fetal deaths/stillbirths and 70000 neonatal deaths. In Brazil, despite national initiatives (e.g., the Rapid Response to Syphilis in Health Care Networks), the burden persists. In 2024, 89724 cases of syphilis in pregnancy were reported and 24443 congenital syphilis cases were notified (incidence 9.6 per 1000 live births). This study explored primary health care workers perceptions of barriers and facilitators to caring for pregnant women with syphilis.
METHODS:
Qualitative study with semi-structured interviews of 27 primary health care workers in the city of São Paulo, the most populated city in Latin America. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. Themes were mapped to domains and constructs of the Consolidated Framework for Implementation Research (CFIR, 2020 version).
RESULTS:
Barriers clustered across CFIR domains: (I) Inner setting: religious influences, stigma related to sexually transmitted infections and insufficient consultation time; (II) Outer setting: structural machismo and ineffective intersectoral coordination; (III) Individuals: regarding the workers, limited prioritization of syphilis care and gaps in technical training and cultural competence; among women, low level of education. Facilitators included coordination with urgent care units, from outer setting; interprofessional collaboration, active outreach to reduce missed appointments, and flexible scheduling, from Process.
CONCLUSIONS:
Improving this women health care requires equity-oriented, culturally inclusive, and sustainable implementation strategies: strengthen communication to address stigma and gender power dynamics, expand competency-based training, and redesign care pathways and intersectoral integration to ensure timely testing, treatment, partner management, and longitudinal follow-up within primary health care.
| eISSN: | 2654-1459 |
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