Barriers to Routine Antenatal Syphilis Screening in Uganda: Provider Perspectives and Practices

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Maternal and Child Health

Background:

• Congenital syphilis is preventable with timely antenatal screening and treatment.
• Despite global declines, undiagnosed syphilis persists in low- and middle-income countries, including Uganda.
• Suboptimal screening coverage at antenatal care (ANC) visits in Uganda contributes to perinatal transmission.

Purpose of the Study:

• To explore healthcare provider perspectives on barriers to antenatal syphilis screening and treatment in Uganda.
• To identify factors hindering effective implementation of national syphilis control guidelines.

Main Methods:

• Qualitative study employing descriptive qualitative approach and thematic analysis.
• Conducted in-depth interviews with 20 ANC providers across six public health facilities in Uganda.
• Focused on understanding provider-identified challenges in syphilis screening and treatment services.

Main Results:

• Identified four key barriers: (1) stockouts of essential supplies (test kits, benzathine penicillin), (2) limited provider training and confidence, (3) divergence between guidelines and practice, and (4) insufficient male partner engagement.
• These barriers collectively disrupt care and increase the risk of reinfection.
• Provider confidence in diagnosis and treatment was reduced by limited access to formal training.

Conclusions:

• Health system strengthening is crucial for eliminating congenital syphilis in Uganda.
• Recommendations include improving supply chain management, ensuring universal provider training, implementing supportive supervision, and enhancing community-based strategies for male partner engagement.
• Addressing identified barriers is essential to reduce perinatal syphilis transmission.