Evaluation of Partner Notification Strategies to Improve Syphilis Management in Pregnancy in Blantyre, Malawi: A Mixed-Methods Study.

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.