Prevention of mother‐to‐child transmission of syphilis and HIV in China: What drives political prioritization and what can this tell us about promoting dual elimination?

Abstract

ObjectiveThe present study aims to identify reasons behind the lower political priority of mother-to-child transmission (MTCT) of syphilis compared with HIV, despite the former presenting a much larger and growing burden than the latter, in China, over the 20 years prior to 2010.MethodsWe undertook a comparative policy analysis, based on informant interviews and documentation review of control of MTCT of syphilis and HIV, as well as nonparticipant observation of relevant meetings/trainings to investigate agenda-setting prior to 2010.ResultsWe identified several factors contributing to the lower priority accorded to MTCT of syphilis: relative neglect at a global level, dearth of international financial and technical support, poorly unified national policy community with weak accountability mechanisms, insufficient understanding of the epidemic and policy options, and a prevailing negative framing of syphilis that resulted in significant stigmatization.ConclusionA dual elimination goal will only be reached when prioritization of MTCT of syphilis is enhanced in both the international and national agendas.

Sociodemographic and obstetric characteristics of stillbirths in China: a census of nearly 4 million health facility births between 2012 and 2014

“…Detection and treatment of syphilis in pregnancy, for example, is substandard, and congenital syphilis is thought to be on the rise. 30 As expected, obstetric complications were associated with an increased risk of stillbirth, 4,31 although about two thirds of all stillbirths were in women without reported maternal complications. The prevalence of maternal complications was similar to the estimates from the WHO global survey for China, 31 but was low compared with that reported in other studies.…”

Educational intervention in Primary Care for the prevention of congenital syphilis

“…Other studies conducted in Brazil 6 , 21 , in China 17 , in Switzerland 12 and in the United States of America 11 reinforced the same flaws and the reappearance of congenital syphilis today.…”

Syphilis screening and treatment: integration with HIV services

“… 6 For example, in China, syphilis was low on the national policy agenda due to limited external support, uncoordinated domestic initiatives, lack of awareness of the problem and its solutions among policymakers and negative issue framing leading to stigma and discrimination. 7 Since 2010, in China, syphilis screening and treatment has been gradually incorporated into HIV counselling and testing sites, 8 and integrated antenatal HIV and syphilis interventions have become a normal part of routine antenatal care. 9 Leveraging the well-established platform of HIV control, including health facilities, staff, supplies and data reporting mechanisms has proven effective not only in enhancing political commitment to combat syphilis but also in mobilizing resources for the expansion of syphilis testing and treatment.…”