# Difficulties with clinical practice guidelines for congenital syphilis prevention in Colombia: a qualitative study

## TL;DR

This study explores why congenital syphilis prevention guidelines in Colombia are not effectively preventing the disease, focusing on two regions.

## Contribution

The study identifies three new gaps in the implementation of clinical practice guidelines for congenital syphilis.

## Key findings

- The CPG is implemented in a fragmented and under-resourced healthcare system.
- CPG implementation involves more than prenatal care and healthcare workers.
- CPG implementation overlaps with protocols for other diseases like HIV and diabetes.

## Abstract

Congenital syphilis (CS) is considered a preventable disease. However, it remains a major public-health concern in Colombia, where healthcare authorities have suggested that the main issue is the incorrect implementation of the clinical practice guidelines (CPG). This study aimed to understand why this preventable disease cannot be prevented in Chocó and Caldas, two regions of Colombia.

A qualitative online study, using a multi-method approach following interpretative and ethnographic online research principles, was conducted in two regions of Colombia (Chocó and Caldas) during the COVID-19 pandemic.

Besides the difficulties of, and barriers to, implementing the CPG identified in other studies in Colombia and elsewhere, three main gaps are highlighted as results of the study. (1) The CPG is usually implemented in a fragmented system. It specifies timelines and trajectories to be met in dynamic, inter-connected and under-resourced systems. (2) The CPG’s implementation requires measures and activities that go before and beyond prenatal care and involve more than pregnant women and healthcare workers. (3) The CPG are for preventing the specific disease, but the implementation is enacted in relation to other diseases (HIV, COVID-19, hepatitis B, hypertension, diabetes) and their protocols and clinical guidelines.

The implementation of the CPG is important but insufficient for CS prevention. The CPG does not operate in isolation. In addition to the knowledge of the CPG and the provision of the necessary resources, it is crucial to consider the activities and processes before and after prenatal care to address the fragmentation of the healthcare system and healthcare services provision. Moreover, it is essential to coordinate the activities and practices for other diseases (HIV, COVID-19, hypertension, hepatitis B, diabetes) with those of the CPG.