The World Health Organization (WHO) acknowledged that, despite advances in prevention and treatment within the scope of the global health sector strategy for HIV, viral hepatitis, and sexually transmitted infections (STIs) for 2016-2021, critical problems persisted (even before the COVID-19 pandemic) which could jeopardize the accomplishment of the 2030 Sustainable Development Goals¹1. World Health Organization. Seventy-fourth World Health Assembly - #WHA74. https://www.who.int/about/governance/world-health-assembly/seventy-fourth-world-health-assembly (acessado em Abr/2022).
https://www.who.int/about/governance/wor... ^,22. World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Accountability for the global health sector strategies 2016-2021: actions for impact. https://apps.who.int/iris/rest/bitstreams/1348210/retrieve (acessado em Abr/2022).
https://apps.who.int/iris/rest/bitstream... . In 2021, the 74th World Health Assembly approved the need for new coping strategies for 2022-2030 ¹1. World Health Organization. Seventy-fourth World Health Assembly - #WHA74. https://www.who.int/about/governance/world-health-assembly/seventy-fourth-world-health-assembly (acessado em Abr/2022).
https://www.who.int/about/governance/wor... . The implementation of health care actions integrated with surveillance and control, ensuring access to primary healthcare (PHC) diagnosis, treatment, and monitoring, has been the major challenge to achieve control of the disease ²2. World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Accountability for the global health sector strategies 2016-2021: actions for impact. https://apps.who.int/iris/rest/bitstreams/1348210/retrieve (acessado em Abr/2022).
https://apps.who.int/iris/rest/bitstream... ^,33. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Agenda estratégica para redução da sífilis no Brasil, 2020-2021. http://bvsms.saude.gov.br/bvs/publicacoes/agenda_reducao_sifilis_2020_2021.pdf (acessado em Abr/2022).
http://bvsms.saude.gov.br/bvs/publicacoe... .

In Brazil, the persistence of syphilis as a public health problem is unequivocal, considering the limitation of access to adequate diagnosis and treatment in the Brazilian Unified National Health System (SUS) care network ³3. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Agenda estratégica para redução da sífilis no Brasil, 2020-2021. http://bvsms.saude.gov.br/bvs/publicacoes/agenda_reducao_sifilis_2020_2021.pdf (acessado em Abr/2022).
http://bvsms.saude.gov.br/bvs/publicacoe... ^,44. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... . The challenge grows in the current political-institutional moment due to PHC unraveling changes in the face of new SUS financing modalities ⁵5. Melo EA, Almeida PF, Lima LD, Giovanella L. Reflexões sobre as mudanças no modelo de financiamento federal da atenção básica à saúde no Brasil. Saúde Debate 2019; 43:137-44.. This new model has been developed since the enactment of the 95th Constitutional Amendment in 2016, which limited public spending due to unprecedented crises and austerity for 20 years ⁵5. Melo EA, Almeida PF, Lima LD, Giovanella L. Reflexões sobre as mudanças no modelo de financiamento federal da atenção básica à saúde no Brasil. Saúde Debate 2019; 43:137-44.^,66. Mendes Á, Melo MA, Carnut L. Análise crítica sobre a implantação do novo modelo de alocação dos recursos federais para atenção primária à saúde: operacionalismo e improvisos. Cad Saúde Pública 2022; 38:e00164621., thus, making room for the deconstruction of SUS universality ⁵5. Melo EA, Almeida PF, Lima LD, Giovanella L. Reflexões sobre as mudanças no modelo de financiamento federal da atenção básica à saúde no Brasil. Saúde Debate 2019; 43:137-44.^,66. Mendes Á, Melo MA, Carnut L. Análise crítica sobre a implantação do novo modelo de alocação dos recursos federais para atenção primária à saúde: operacionalismo e improvisos. Cad Saúde Pública 2022; 38:e00164621., generating, in addition to limited access, the expansion of inequalities, affecting the control of syphilis.

Data from the Brazilian Ministry of Health from 2012 to 2018 indicate a variation in the detection rate of acquired syphilis (per 100,000 inhabitants) from 14.4 to 74.4 and from 5.7 to 21.5 in pregnant women, as well as in the incidence rate of congenital syphilis (per 1,000 live births), from 4.0 to 9.0 ⁴4. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... ^,77. Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian protocol for sexually transmitted infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021; 54:e2020597.. This increase is associated with factors such as access to rapid testing, misinformation, decline in the use of condoms, reduced use of benzathine penicillin in PHC, and drug shortage ⁸8. Grumach AS, Matida LH, Heukelbach J, Coêlho HLL, Ramos Júnior AN. A (des)informação relativa à aplicação da penicilina na rede do sistema de saúde do Brasil: o caso da sífilis. DST J Bras Doenças Sex Transm 2007; 19:120-7.^,99. Araujo RS, Souza ASS, Braga JU. Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? Rev Saúde Pública 2020; 54:109.. Limited access to the active pharmaceutical input of penicillin has brought great challenges ⁴4. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... ^,88. Grumach AS, Matida LH, Heukelbach J, Coêlho HLL, Ramos Júnior AN. A (des)informação relativa à aplicação da penicilina na rede do sistema de saúde do Brasil: o caso da sífilis. DST J Bras Doenças Sex Transm 2007; 19:120-7.^,99. Araujo RS, Souza ASS, Braga JU. Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? Rev Saúde Pública 2020; 54:109.. Shortage in health services in the municipality of Rio de Janeiro showed non-homogeneity over time (2014, 2015, and 2017) and space, especially in poorer programmatic areas with greater syphilis detection ⁹9. Araujo RS, Souza ASS, Braga JU. Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? Rev Saúde Pública 2020; 54:109..

Despite the magnitude of syphilis, Brazilian data can translate underreporting underestimates, compromising health planning actions ³3. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Agenda estratégica para redução da sífilis no Brasil, 2020-2021. http://bvsms.saude.gov.br/bvs/publicacoes/agenda_reducao_sifilis_2020_2021.pdf (acessado em Abr/2022).
http://bvsms.saude.gov.br/bvs/publicacoe... ^,44. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... ^,1010. Domingues CSB, Lannoy LH, Saraceni V, Cunha ARCD, Pereira GFM. Brazilian protocol for sexually transmitted infections 2020: epidemiological surveillance. Rev Soc Bras Med Trop 2021; 54:e2020549.. We also highlight the effect of COVID-19 with reduced case detection ³3. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Agenda estratégica para redução da sífilis no Brasil, 2020-2021. http://bvsms.saude.gov.br/bvs/publicacoes/agenda_reducao_sifilis_2020_2021.pdf (acessado em Abr/2022).
http://bvsms.saude.gov.br/bvs/publicacoe... in 2020-2021.

Proper diagnosis and treatment during pregnancy can prevent congenital syphilis ²2. World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Accountability for the global health sector strategies 2016-2021: actions for impact. https://apps.who.int/iris/rest/bitstreams/1348210/retrieve (acessado em Abr/2022).
https://apps.who.int/iris/rest/bitstream... ^,33. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Agenda estratégica para redução da sífilis no Brasil, 2020-2021. http://bvsms.saude.gov.br/bvs/publicacoes/agenda_reducao_sifilis_2020_2021.pdf (acessado em Abr/2022).
http://bvsms.saude.gov.br/bvs/publicacoe... ^,44. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... ^,77. Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian protocol for sexually transmitted infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021; 54:e2020597.^,1010. Domingues CSB, Lannoy LH, Saraceni V, Cunha ARCD, Pereira GFM. Brazilian protocol for sexually transmitted infections 2020: epidemiological surveillance. Rev Soc Bras Med Trop 2021; 54:e2020549.. Its persistence evinces maternal and childcare problems (especially prenatal care) due to non-access to diagnosis, late access to results or inadequate, interrupted or absent maternal syphilis treatment ⁷7. Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian protocol for sexually transmitted infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021; 54:e2020597.. We reiterate that prenatal care should involve fathers’ or partners’ participation to diagnose syphilis or other STIs with adequate treatment ⁷7. Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian protocol for sexually transmitted infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021; 54:e2020597.^,1010. Domingues CSB, Lannoy LH, Saraceni V, Cunha ARCD, Pereira GFM. Brazilian protocol for sexually transmitted infections 2020: epidemiological surveillance. Rev Soc Bras Med Trop 2021; 54:e2020549..

Brazil has recorded an increase in prenatal coverage, with regional differences which also include quality of care ⁷7. Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian protocol for sexually transmitted infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021; 54:e2020597.^,1111. Benzaken AS, Pereira GFM, Cunha ARCD, Souza FMA, Saraceni V. Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals. Cad Saúde Pública 2019; 36:e00057219.^,1212. Tomasi E, de Assis TM, Muller PG, da Silveira DS, Neves RG, Fantinel E, et al. Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: what can (and should) improve? PLoS One 2022; 17:e0262217.. The analysis of data from 2012 to 2018, available via the three cycles of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB), showed an increase trend (from 71% to 81%) in the proportion of women with prenatal PHC ¹²12. Tomasi E, de Assis TM, Muller PG, da Silveira DS, Neves RG, Fantinel E, et al. Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: what can (and should) improve? PLoS One 2022; 17:e0262217..

A study in Brazilian capitals recognized an about 80% average rate of prenatal care adequacy, with heterogeneous performance among regions. Prenatal inadequacy was associated with a worse Municipal Human Development Index (MHDI), age below 20 years, less than four years of schooling, non-white race/skin color, and absence of a partner ¹¹11. Benzaken AS, Pereira GFM, Cunha ARCD, Souza FMA, Saraceni V. Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals. Cad Saúde Pública 2019; 36:e00057219.. In turn, gestational syphilis cases were associated with a higher proportion of adolescents, low schooling level, and non-white race/skin color. Almost 20% of the mothers of children with congenital syphilis had no prenatal consultations - seven times more than the general population. Moreover, the data show poor gestational syphilis diagnosis, management, and treatment. The PMAQ-AB analysis showed insufficient availability of the following inputs: 27.3% for rapid syphilis tests, 67.7% for benzathine benzylpenicillin, and 86.7% for administration by PHC teams ¹¹11. Benzaken AS, Pereira GFM, Cunha ARCD, Souza FMA, Saraceni V. Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals. Cad Saúde Pública 2019; 36:e00057219..

Syphilis has a high and increasing prevalence in vulnerable populations, especially men who have sex with men, sex workers, and people deprived of liberty, with regional differences ³3. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Agenda estratégica para redução da sífilis no Brasil, 2020-2021. http://bvsms.saude.gov.br/bvs/publicacoes/agenda_reducao_sifilis_2020_2021.pdf (acessado em Abr/2022).
http://bvsms.saude.gov.br/bvs/publicacoe... ^,44. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... . The dimensions of vulnerability in syphilis are also visible in its higher proportion in women, especially brown/black ones ⁴4. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... . The prevalence of at least one STI in quilombola women was estimated at 18.5% (syphilis, 4.3%) if they had low schooling level and limited access to health services ¹³13. Dias JA, Luciano TV, Santos MCLFS, Musso C, Zandonade E, Spano LC, et al. Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados. Cad Saúde Pública 2021; 37:e00174919..

The First National Survey of Indigenous People’s Health and Nutrition (almost 4,000 women) showed significant ethnic-racial inequalities. It found less access to prenatal care, when compared to non-indigenous women and populations with high social vulnerability and low health care coverage (Legal Amazon and Northeast). Only 16% of indigenous pregnant women had six or more prenatal consultations and out of these, 57.6% had requested syphilis tests ¹⁴14. Garnelo L, Horta BL, Escobar AL, Santos RV, Cardoso AM, Welch JR, et al. Avaliação da atenção pré-natal ofertada às mulheres indígenas no Brasil: achados do Primeiro Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas. Cad Saúde Pública 2019; 35:e00181318..

Unequal access to prenatal consultations and timely testing to diagnose HIV infection and syphilis has also been verified. Individual factors related to pregnant women’s schooling level contribute to this, as does contextual factors related to MHDI and Gini index ¹⁵15. Freitas CHSM, Forte FDS, Galvão MHR, Coelho AA, Roncalli AG, Dias SMF. Inequalities in access to HIV and syphilis tests in prenatal care in Brazil. Cad Saúde Pública 2019; 35:e00170918..

The national response to vertical transmission by HIV in relation to that of Treponema pallidum⁴4. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... ^,1616. Ramos Jr. AN, Matida LH, Saraceni V, Veras MASM, Pontes RJS. Control of mother-to-child transmission of infectious diseases in Brazil: progress in HIV/AIDS and failure in congenital syphilis. Cad Saúde Pública 2007; 23 Suppl 3:S370-8.^,1717. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - HIV/Aids 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-hivaids-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... shows differences. The difference observed in surveillance and prevention actions, and prenatal care and newborn exposed children, shows better HIV management, with regional differences ¹⁶16. Ramos Jr. AN, Matida LH, Saraceni V, Veras MASM, Pontes RJS. Control of mother-to-child transmission of infectious diseases in Brazil: progress in HIV/AIDS and failure in congenital syphilis. Cad Saúde Pública 2007; 23 Suppl 3:S370-8.. The detection rate of HIV infection in pregnant women in 2010 was 2.1 cases/1,000 live births and, in 2020, 2.7, with a regional increase, especially in the Brazilian North and Northeast. However, AIDS detection rates in children aged under five years - a proxy for monitoring vertical HIV transmission - decreased by almost 70% in the 10 analyzed years ¹⁷17. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - HIV/Aids 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-hivaids-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... .

PHC “longitudinality” should be recognized as a SUS dimension to control syphilis. The verification of the low proportion of women with puerperal consultation limits significant meetings with healthcare providers, negatively affecting women and children’s current and future health ¹⁸18. Baratieri T, Lentsck MH, Falavina LP, Soares LG, Prezotto KH, Pitilin ÉB. Longitudinalidade do cuidado: fatores associados à adesão à consulta puerperal segundo dados do PMAQ-AB. Cad Saúde Pública 2022; 38:e00103221.. It also includes the equitable distribution of health services to overcome restrictions on the universalization of access ⁵5. Melo EA, Almeida PF, Lima LD, Giovanella L. Reflexões sobre as mudanças no modelo de financiamento federal da atenção básica à saúde no Brasil. Saúde Debate 2019; 43:137-44.^,66. Mendes Á, Melo MA, Carnut L. Análise crítica sobre a implantação do novo modelo de alocação dos recursos federais para atenção primária à saúde: operacionalismo e improvisos. Cad Saúde Pública 2022; 38:e00164621.^,99. Araujo RS, Souza ASS, Braga JU. Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? Rev Saúde Pública 2020; 54:109.^,1313. Dias JA, Luciano TV, Santos MCLFS, Musso C, Zandonade E, Spano LC, et al. Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados. Cad Saúde Pública 2021; 37:e00174919.^,1414. Garnelo L, Horta BL, Escobar AL, Santos RV, Cardoso AM, Welch JR, et al. Avaliação da atenção pré-natal ofertada às mulheres indígenas no Brasil: achados do Primeiro Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas. Cad Saúde Pública 2019; 35:e00181318.^,1515. Freitas CHSM, Forte FDS, Galvão MHR, Coelho AA, Roncalli AG, Dias SMF. Inequalities in access to HIV and syphilis tests in prenatal care in Brazil. Cad Saúde Pública 2019; 35:e00170918..

We recognize the need to advance the discussion on syphilis control and the CSP have sought to contribute throughout its trajectory. It published about 40 related articles since 1985. Its most recent one is in this issue ¹⁹19. Saes MO, Duro SMS, Gonçalves CS, Tomasi E, Facchini LA. Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018. Cad Saúde Pública 2022; 38:e00231921., entitled Assessment of the Appropriate Management of Syphilis Patients in Primary Health Care in Different Regions of Brazil from 2012 to 2018, authored by Mirelle de Oliveira Saes (Federal University of Rio Grande) et al., with consistent evidence in view of the limitation of evidence in the undertaken approach.

In addition to changes in the political-institutional and socioeconomic context of Brazil, the period of this study includes the expansion of PHC coverage and different government initiatives to qualify actions to control syphilis and other STIs ⁴4. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... ^,77. Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian protocol for sexually transmitted infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021; 54:e2020597.^,99. Araujo RS, Souza ASS, Braga JU. Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? Rev Saúde Pública 2020; 54:109., with an increase in the number of syphilis cases ⁴4. Secretaria de Vigilância em Saúde, Ministério da Saúde. Boletim Epidemiológico - Sífilis 2021; (número especial). http://www.aids.gov.br/pt-br/pub/2021/boletim-epidemiologico-de-sifilis-2021.
http://www.aids.gov.br/pt-br/pub/2021/bo... .

It is an epidemiological research based on national estimates of annual changes in infrastructure and work processes to diagnose, to manage, and to treat the disease. The analysis is based on data from external PMAQ-AB evaluation, considering the three available cycles (2012, 2014, and 2018) ¹⁹19. Saes MO, Duro SMS, Gonçalves CS, Tomasi E, Facchini LA. Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018. Cad Saúde Pública 2022; 38:e00231921.. Contextual variables included macroregion, municipality housing capacity, MHDI, and coverage of the Family Health Strategy (FHS).

The reach, the progressive participation of municipalities and PHC teams, and the evaluative potential made possible by the PMAQ-AB is remarkable ¹⁹19. Saes MO, Duro SMS, Gonçalves CS, Tomasi E, Facchini LA. Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018. Cad Saúde Pública 2022; 38:e00231921.. The program has been recognized as an innovative and very useful action to induce the improvement of PHC quality at SUS ¹⁹19. Saes MO, Duro SMS, Gonçalves CS, Tomasi E, Facchini LA. Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018. Cad Saúde Pública 2022; 38:e00231921.^,2020. Uchôa SAC, Martiniano CS, Queiroz AAR, Bay Júnior OG, Nascimento WG, Diniz ÍVA, et al. Inovação e utilidade: avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Saúde Debate 2018; 42:100-13..

Despite the progress in the percentage change in the parameters of adequate infrastructure and proper work process, it does not reach the necessary conditions for controlling syphilis. There are inequities, with more positive results in richer regions, municipalities with higher MHDI, greater housing capacity, and lower FHS coverage ¹⁹19. Saes MO, Duro SMS, Gonçalves CS, Tomasi E, Facchini LA. Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018. Cad Saúde Pública 2022; 38:e00231921.. These findings are relevant, even though it is impossible to establish inferences on the relation between adequate infrastructure and work process with attention and care to people with syphilis in PHC ¹⁹19. Saes MO, Duro SMS, Gonçalves CS, Tomasi E, Facchini LA. Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018. Cad Saúde Pública 2022; 38:e00231921.^,2020. Uchôa SAC, Martiniano CS, Queiroz AAR, Bay Júnior OG, Nascimento WG, Diniz ÍVA, et al. Inovação e utilidade: avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Saúde Debate 2018; 42:100-13..

The inclusion of PMAQ-AB data has been undertaken in studies dealing with different themes, allowing for the integration of perspectives and showing critical issues in the SUS ²⁰20. Uchôa SAC, Martiniano CS, Queiroz AAR, Bay Júnior OG, Nascimento WG, Diniz ÍVA, et al. Inovação e utilidade: avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Saúde Debate 2018; 42:100-13.. In a study on the availability of inputs for reproductive planning, there was an increase from 1.5% to 10.9%, with worse results in Northern Brazil. Higher increases were observed in health units in municipalities with lower MHDI and which adhered to all cycles ²¹21. Ruivo ACO, Facchini LA, Tomasi E, Wachs LS, Fassa AG. Disponibilidade de insumos para o planejamento reprodutivo nos três ciclos do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica: 2012, 2014 e 2018. Cad Saúde Pública 2021; 37:e00123220.. Another nationwide study, considering the three PMAQ-AB cycles from the perceptions of female users, indicated that expanded and timely provision of prenatal care in the PHC network is an insufficient condition to ensure successful pregnancy. It reiterated that the prevention of unfavorable outcomes to maternal and child health requires adequate, integrated, and longitudinal care during pregnancy, childbirth, and puerperium ¹⁸18. Baratieri T, Lentsck MH, Falavina LP, Soares LG, Prezotto KH, Pitilin ÉB. Longitudinalidade do cuidado: fatores associados à adesão à consulta puerperal segundo dados do PMAQ-AB. Cad Saúde Pública 2022; 38:e00103221..

The relation between diagnosis coverage and syphilis treatment in PHC and its gestational and congenital incidence was also evaluated in research of the second PMAQ-AB cycle. Administration of penicillin and rapid testing in the municipalities reached proportions of 41.9% and 67.1%, respectively, with regional differences. The incidence of gestational syphilis was higher in municipalities with a higher supply of rapid testing, indicating greater detection capacity. On the other hand, municipalities with reduced vertical transmission of T. pallidum showed a higher supply of rapid tests and administration of benzathine penicillin ²²22. Figueiredo DCMM, Figueiredo AM, Souza TKB, Tavares G, Vianna RPT. Relação entre oferta de diagnóstico e tratamento da sífilis na atenção básica sobre a incidência de sífilis gestacional e congênita. Cad Saúde Pública 2020; 36:e00074519..

Despite its widely documented relevance, PMAQ-AB was discontinued by the Federal Government in early 2019 and was replaced by the Prevent Brazil programme. Since 2020 this change has implied a setback in the financing process and PHC evaluation ⁶6. Mendes Á, Melo MA, Carnut L. Análise crítica sobre a implantação do novo modelo de alocação dos recursos federais para atenção primária à saúde: operacionalismo e improvisos. Cad Saúde Pública 2022; 38:e00164621.^,77. Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian protocol for sexually transmitted infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021; 54:e2020597.^,1919. Saes MO, Duro SMS, Gonçalves CS, Tomasi E, Facchini LA. Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018. Cad Saúde Pública 2022; 38:e00231921..

The challenges are broad and require research and broad engagement in defense of SUS. Collective Health, as a scientific field and movement, plays a relevant role in generating evidence not only by Epidemiology (the main perspective of the highlighted article) but also by Social and Human Sciences, and the Health Policy, Management and Planning.

A recent document of the Brazilian Association of Collective Health (Abrasco) ²³23. Associação Brasileira de Saúde Coletiva. Fortalecer o SUS, em defesa da democracia e da vida. https://www.abrasco.org.br/site/categorias-interna/outras-publicacoes/fortalecer-o-sus-em-defesa-da-democracia-e-da-vida/53604/ (acessado em Abr/2022).
https://www.abrasco.org.br/site/categori... analyzes the current SUS situation in the context of COVID-19, with established proposals. It aims to support greater reflection, in addition to provide subsidies to build agendas based on science and strengthen SUS. Among its proposals are ensuring regular and sufficient funding for the population’s health needs; adapting care model to needs; strengthening and consolidating the public character of SUS; expanding political, organizational, and operative integration in SUS; improving SUS management in a democratic and participatory manner; ensuring the occupation of management positions on a technical basis; implement an integrated personnel policy for SUS and sustaining a policy of health science, technology, and innovation ²³23. Associação Brasileira de Saúde Coletiva. Fortalecer o SUS, em defesa da democracia e da vida. https://www.abrasco.org.br/site/categorias-interna/outras-publicacoes/fortalecer-o-sus-em-defesa-da-democracia-e-da-vida/53604/ (acessado em Abr/2022).
https://www.abrasco.org.br/site/categori... .

Therefore, achieving syphilis control in Brazil necessarily requires us to follow the paths to strengthen SUS in defense of democracy and life.

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