Sexually transmitted diseases · 2026
Evaluation of Partner Notification Strategies to Improve Syphilis Management in Pregnancy in Blantyre, Malawi: A Mixed-Methods Study.
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Kaunda Kondwani Kaitume, Foley Deirdre J, Marks Michael, Majamanda Annielisa, Malata Monica Patricia, Bamuya Catherine, Kondoni Chifundo, Gadama Gladys Membe, Lissauer David, Morroni Chelsea, MacPherson Peter, Chipeta Effie, Mipando Linda, Gilmore Brynne, Freyne Bridget
Аннотация
BACKGROUND: Congenital syphilis remains a major global health challenge, driven partly by maternal reinfection during pregnancy. Partner notification (PN) is critical to prevent reinfection and reduce mother-to-child transmission, yet evidence on its uptake and effectiveness is limited. We aimed to assess PN coverage, outcomes, and barriers among pregnant women with syphilis in Blantyre, Malawi.
METHODS: We conducted a mixed-methods study at 4 primary health centers (Mpemba, Zingwangwa, South Lunzu, and Bangwe). A cross-sectional survey at delivery enrolled women with documented syphilis in the current pregnancy (positive treponemal rapid diagnostic test). PN was defined as informing partners of potential exposure and the need for testing; appropriate partner management was defined as partner testing and treatment according to results. Semistructured interviews with women and healthcare workers were analyzed using reflexive thematic analysis.
RESULTS: Among 131 women, 117/131 (89.3%) reported notifying partners; however, only 76/131 (58.0%) partners were tested, and a similar but nonidentical 76/131 (58.0%) received treatment. Appropriate partner management was completed in 40/131 (30.5%). Partner treatment was associated with being married or cohabiting (74/76, 97.4% vs 43/55, 78.2%; P = 0.0005), but not with age, HIV status, education, or adverse birth outcomes. Qualitative findings identified predominantly patient-led PN, with barriers, including fear of partner reaction, stigma, misinformation, and partner reluctance to access care; facilitators included community sensitization and healthcare worker involvement.
CONCLUSIONS: Substantial attrition occurs between notification and partner management, highlighting critical gaps in the cascade. These findings support the need for standardized PN metrics and context-specific, multicomponent interventions addressing health system barriers.
METHODS: We conducted a mixed-methods study at 4 primary health centers (Mpemba, Zingwangwa, South Lunzu, and Bangwe). A cross-sectional survey at delivery enrolled women with documented syphilis in the current pregnancy (positive treponemal rapid diagnostic test). PN was defined as informing partners of potential exposure and the need for testing; appropriate partner management was defined as partner testing and treatment according to results. Semistructured interviews with women and healthcare workers were analyzed using reflexive thematic analysis.
RESULTS: Among 131 women, 117/131 (89.3%) reported notifying partners; however, only 76/131 (58.0%) partners were tested, and a similar but nonidentical 76/131 (58.0%) received treatment. Appropriate partner management was completed in 40/131 (30.5%). Partner treatment was associated with being married or cohabiting (74/76, 97.4% vs 43/55, 78.2%; P = 0.0005), but not with age, HIV status, education, or adverse birth outcomes. Qualitative findings identified predominantly patient-led PN, with barriers, including fear of partner reaction, stigma, misinformation, and partner reluctance to access care; facilitators included community sensitization and healthcare worker involvement.
CONCLUSIONS: Substantial attrition occurs between notification and partner management, highlighting critical gaps in the cascade. These findings support the need for standardized PN metrics and context-specific, multicomponent interventions addressing health system barriers.