Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018

Abstract

This study aimed to analyze the presence of adequate infrastructure and work process in primary health care for the diagnosis, management, and treatment of syphilis in Brazil in 2012, 2014, and 2018. This is a cross-sectional, nationwide study with data from the three cycles of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB): 2012 (Cycle I), 2014 (Cycle II), and 2018 (Cycle III). Two outcomes were assessed: adequate infrastructure and work process. The independent variables were macroregion, municipality size, Municipal Human Development Index (HDI-M), and coverage of the Family Health Strategy (FHS). Variance-weighted least squares regression was used to estimate annual changes in percentage. In total, 13,842 primary basic health units (UBS) and 17,202 professional health care teams were assessed in Cycle I; 24,055 UBS and 29,778 teams in Cycle II, and 28,939 UBS and 37,350 teams in Cycle III. About 1.4% of UBS had adequate infrastructure in Cycle I; 17.5% had in Cycle II; and 42.7% had in Cycle III. Adequate work process also increased in the three cycles, ranging from 47.3% in Cycle I to 45.5% in Cycle II and 75.4% in Cycle III. However, inequities are observed, considering that richer regions and larger municipalities, with higher HDI-M and lower FHS coverage improved the most. The low prevalence of adequate infrastructure and work process for the care of patients with syphilis in Brazil reflects a significant weakness in the Brazilian health system.

Serviços de rastreamento de infecções sexualmente transmissíveis: Discussão de acesso

“…A acessibilidade deve ser levada em consideração quando da implantação de políticas públicas, em especial, para as populações mais vulneráveis, que historicamente já demostram dificuldades em acessar os serviços de saúde. 16 Há três níveis de barreiras de acesso: individual, comunitário e do próprio sistema de saúde. 17 O primeiro está relacionado às questões de estigma internalizado nos pacientes, percepção de ser visto como anormal e baixa autoestima, características principalmente encontra-das entre as mulheres trans, baixo nível socioeconômico, que os levam a falta de recursos para transporte e despesas médicas.…”

“…Há persistência histórica de desigualdades na distribuição da infraestrutura adequada de UBS no Brasil, ressaltando a maior fragilidade no atendimento aos mais pobres e vulneráveis. 16 O fortalecimento da atenção básica é o caminho para a melhora da qualidade dos serviços, promovendo a melhoria da acessibilidade, pois é um espaço onde se consegue abordar as questões de confidencialidade, privacidade e de estigma. O estigma e a rejeição da sociedade frequentemente resultam em comportamentos de recusa em procurar serviço de saúde, atrasando o diagnóstico, interferindo na notificação efetiva do parceiro e, consequentemente, impedindo o controle das epidemias de IST.…”

Gestational and congenital syphilis across the international border in Brazil

“…These data are in agreement with the sociodemographic characteristics described in other studies [ 13 , 27 – 29 ]. However, the expansion of primary health care in Brazil led to an increase in prenatal coverage and the coverage of prenatal screening exams, a measure that expanded access and service as well as improved the diagnosis and notification of syphilis cases in the country [ 30 – 32 ].…”

“…The notification on the staging of the clinical phases of syphilis showed that more than 30% were reported as primary syphilis, 9% as tertiary syphilis and 21% as not informed. Since most cases in pregnant women are asymptomatic, diagnosed by serological tests in the latent form of infection [ 33 ], these data may be classification errors and provide evidence of the need to continuously train health care providers to improve the possibility of adequate treatment and the quality of surveillance data in the border region [ 30 ].…”

Salus Platform: A Digital Health Solution Tool for Managing Syphilis Cases in Brazil—A Comparative Analysis

“…Syphilis is a sexually transmitted infection (STI) that is systemic and caused by Treponema pallidum. It constitutes to present a serious public health problem in Brazil and the world [ 1 , 2 , 3 , 4 ], despite the existence of methods of prevention, diagnosis, and treatment with an antibiotic, which is widely used as the gold standard for treating syphilis [ 5 , 6 , 7 , 8 , 9 ]. Moreover, it presents substantial morbidity, mortality, and chronic evolution and is a gateway to other STIs [ 10 , 11 , 12 , 13 , 14 ].…”