Avaliação do Projeto de Resposta Rápida à Sífilis: análise temporal e espacial da sífilis gestacional e morbimortalidade por sífilis congênita em municípios de Minas Gerais

Abstract

Introduction: Syphilis, caused by the etiological agent Treponema pallidum, is a chronic, curable, systemic bacterial infection exclusive to humans, with high morbimortality in vulnerable populations. Considering the importance of implementing governmental strategies, the Ministry of Health initiated the Rapid Response to Syphilis in the Attention Care Networks Project, aiming to contain the epidemic's progression in the country. Objective: To evaluate the effectiveness of the Rapid Response to Syphilis Project in reducing syphilis occurrences in pregnant women and the morbimortality associated with congenital syphilis in municipalities in the state of Minas Gerais, Brazil. Methods: An ecological study with analyses of temporal and spatial variations in syphilis detection rates in pregnant women and the incidence and mortality of congenital syphilis from 2013 to 2022, having as observation units the eligible and ineligible municipalities for Project implementation in the metropolitan region of Belo Horizonte. Data were obtained from the Notifiable Diseases Information System (SINAN) and the Live Births Information System (SINASC). Spatial analysis involved mapping smoothed rates using the empirical Bayesian local estimator. Global temporal analysis employed generalized linear models (GLM) and Generalized Additive Models (GAM). Socioeconomic and health access factors associated with syphilis were addressed spatially through the Bivariate Moran Index. Results: There was an average increase in the risk of syphilis occurrence in pregnant women and congenital syphilis before and after Project implementation in both groups of municipalities, with a tendency to increase cases in pregnant women and a non-significant drop in congenital syphilis incidence. Deaths from the disease showed a falling trend after Project implementation. municipalities with lower average proportions of health indicator vulnerabilities, exhibited higher average incidences of congenital syphilis and average detection rates in pregnant women during the study period. Associations between rates and indicators of social inequality measures (HDI and Gini Index) were more significant in municipalities near the capital, which had higher average levels of social inequality and higher rates. Conclusion: The results found in this study, indicate limited effectiveness and the need for program expansion and reformulation, as most eligible municipalities experienced an increase or stability in syphilis morbimortality, as well as high rates with a significant increase were also observed in ineligible municipalities. Thus, this study reinforces the necessity of improving public policies, understanding the profiles of those affected, and planning control actions accordingly. The Rapid Response Project and other outlined policies and interventions require ongoing monitoring, adjustments, and expansion to territories focusing on more susceptible populations.