Pinto Rafael, Valentim Ricardo, Fernandes da Silva Lyrene, Fontoura de Souza Gustavo, Góis Farias de Moura Santos Lima Thaísa, Pereira de Oliveira Carlos Alberto, Marques Dos Santos Marquiony, Espinosa Miranda Angélica, Cunha-Oliveira Aliete, Kumar Vivekanandan, Atun Rifat
Federal University of Rio Grande do Norte, Natal, RN, Brazil.
Laboratory of Technological Innovation in Health (LAIS), Natal, RN, Brazil.
Lancet Reg Health Am. 2021 Dec 27;7:100163. doi: 10.1016/j.lana.2021.100163. eCollection 2022 Mar.
BACKGROUND: To fight against the rising incidence of syphilis, the Brazilian Ministry of Health (MoH) launched the "Syphilis No!" Project (SNP), with specific resources funded by a parliamentary amendment. Then, in 2018, a national rapid response started to be implemented on the Brazilian Unified Health System (SUS, Sistema Único de Saúde) in two strategic lines (1) to reinforce SUS's universal actions and (2) to implement specific ones to 100 municipalities chosen by the MoH as priorities for syphilis congenital response. In 2015, such localities represented 6895% of congenital syphilis cases in Brazil. In this context, SNP has implemented actions to strengthen epidemiological surveillance of acquired syphilis and congenital syphilis by instituting an integrated and collaborative response through health services networks and reinforcing interstate relations. METHODS: A quasi-experimental study using time series analysis was conducted to assess immediate impacts and changes to the trend in national congenital syphilis before and after the project, from September 2016 to December 2019. Data were assessed considering rates of congenital syphilis per 1,000 live births in all priority municipalities (n=100) covered by the project and in non-priority municipalities (n=5,470) from all five macro-regions of Brazil. FINDINGS: Priority municipalities showed a greater reduction (change in trend) in comparison to non-priority. The linear regression model revealed trend changes after the intervention, with both groups of municipalities showing a drop in the average monthly number of cases per 1,000 live births, with a reduction of -0·21 (CI 95% -0·33 to -0·09; =0·0011) in priority municipalities and of -0·10 (CI 95% -0.19 to -0.02; =0·0216) in non-priority municipalities. INTERPRETATION: The study using ITS provides important evidence on the direction, timing, and magnitude of the effects of interventions introduced as part of the SNP on congenital syphilis in Brazil. Our results suggest that the Syphilis No! Project influenced the trends of congenital syphilis in Brazil from 2018, with higher reductions achieved in the priority municipalities. FUNDING: The research is funded by a grant to the Syphilis No! Project from Brazilian Ministry of Health (Project Number: 54/2017). The funders had no role in study design, analysis, decision to publish, or preparation of the manuscript.
背景：为应对梅毒发病率的上升，巴西卫生部发起了“梅毒零容忍！”项目（SNP），该项目有议会修正案提供的专项资金。随后，2018年，巴西统一卫生系统（SUS，Sistema Único de Saúde）开始在两条战略路线上实施全国快速响应措施：（1）加强SUS的普遍行动；（2）对卫生部选定的100个作为先天性梅毒应对重点的城市实施特定行动。2015年，这些地区的先天性梅毒病例占巴西的68.95%。在此背景下，SNP通过卫生服务网络建立综合协作应对机制并加强州际关系，采取行动加强对后天梅毒和先天性梅毒的流行病学监测。 方法：采用时间序列分析的准实验研究，评估2016年9月至2019年12月项目前后全国先天性梅毒趋势的即时影响和变化。评估数据时考虑了该项目覆盖的所有重点城市（n = 100）以及巴西五个宏观区域的非重点城市（n = 5470）每1000例活产中的先天性梅毒发病率。 结果：与非重点城市相比，重点城市的下降幅度更大（趋势变化）。线性回归模型显示干预后趋势发生变化，两组城市每1000例活产的月均病例数均有所下降，重点城市下降了-0.21（95%CI -0.33至-0.09；P = 0.0011），非重点城市下降了-0.10（95%CI -0.19至-0.02；P = 0.0216）。 解读：使用ITS进行的这项研究为作为SNP一部分引入的干预措施对巴西先天性梅毒的影响方向、时间和程度提供了重要证据。我们的结果表明，“梅毒零容忍！”项目从2018年开始影响了巴西先天性梅毒的趋势，重点城市的下降幅度更大。 资金来源：该研究由巴西卫生部授予“梅毒零容忍！”项目的一笔赠款资助（项目编号：54/2017）。资助者在研究设计、分析、决定发表或撰写稿件方面没有任何作用。
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