{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:05:08Z","timestamp":1790103908792,"version":"4.0.1"},"reference-count":37,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,4]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Background<\/jats:title>\n Syphilis remains a significant global health burden, with congenital syphilis (CS) posing a major threat to child health. China has implemented the elimination of mother-to-child transmission (EMTCT) programme for syphilis through integrated strategies. However, few studies have analysed granular data along the entire cascade of care to identify specific bottlenecks.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We aimed to characterise the implementation status of integrated interventions in Baoan District, Shenzhen, and to identify risk factors associated with suboptimal indicators.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective cross-sectional study used data from the information system for the prevention of mother-to-child transmission of syphilis in Baoan District (2017\u20132024). Indicators were compared between the pre-practice (2017\u20132018)\u2009and post-practice (2019\u20132024) periods using Pearson\u2019s\n \u03c7\u00b2<\/jats:italic>\n test. Joinpoint regression models were used to estimate annual percentage change (\n APC<\/jats:italic>\n ) during the post-practice period. Univariate and multivariable logistic regression analyses were used to identify factors associated with indicators failing to meet predefined targets.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 752 pregnant women with syphilis and 769 exposed liveborn infants were finally included. Compared with the pre-practice period, significant upward trends were observed in the post-practice period across all process indicators (all p<0.05), while no statistically significant decline in live birth CS incidence was observed between the two periods (2.92 vs 1.59 per 100\u2009000 live births, p=0.70). During 2019\u20132024, antenatal screening coverage (\n APC<\/jats:italic>\n =0.23, p=0.01) and first-trimester screening coverage (\n APC<\/jats:italic>\n =6.79, p=0.01) showed significant upward trends. However, adequate treatment coverage plateaued (\n APC<\/jats:italic>\n =0.41, p=0.67), with the 2024 rate of 87.74% (below the 90% target). Multivariable analysis identified four independent risk factors for inadequate treatment: ethnic minority background (\n aOR<\/jats:italic>\n =2.41,\n 95%<\/jats:italic>\n \u2009CI 1.09 to 5.35), first antenatal visit at \u226513 weeks (\n aOR<\/jats:italic>\n =2.30,\n 95%<\/jats:italic>\n \u2009CI 1.09 to 4.84), <5 antenatal visits (\n aOR<\/jats:italic>\n =3.14,\n 95%<\/jats:italic>\n \u2009CI 1.55 to 6.33) and partner not tested for syphilis (\n aOR<\/jats:italic>\n =2.07,\n 95%<\/jats:italic>\n \u2009CI 1.07 to 4.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n EMTCT process indicators showed favourable trends during the integrated implementation period in Baoan District. However, gaps in achieving the treatment adequacy target highlight critical bottlenecks. Targeted interventions for high-risk populations, including ethnic minorities, women with late or insufficient antenatal care and those with untested partners, are essential to further achieve EMTCT goals.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-122320","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:36:02Z","timestamp":1790102162000},"page":"e122320","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation and performance of a national pilot programme for eliminating mother-to-child transmission of syphilis: a retrospective cross-sectional study in China"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8410-1532","authenticated-orcid":false,"given":"Yali","family":"Luo","sequence":"first","affiliation":[{"name":"Shenzhen Baoan Women's and Children\u2019s Hospital, Shenzhen, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7478-2781","authenticated-orcid":false,"given":"Quanfu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shenzhen Baoan Women's and Children\u2019s Hospital, Shenzhen, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3778-3123","authenticated-orcid":false,"given":"Jiahong","family":"Chen","sequence":"additional","affiliation":[{"name":"Shenzhen Baoan Women's and Children\u2019s Hospital, Shenzhen, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4137-5048","authenticated-orcid":false,"given":"Weizhen","family":"Mai","sequence":"additional","affiliation":[{"name":"Shenzhen Baoan Women's and Children\u2019s Hospital, Shenzhen, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6967-573X","authenticated-orcid":false,"given":"Dingyan","family":"Lv","sequence":"additional","affiliation":[{"name":"Shenzhen Baoan Women's and Children\u2019s Hospital, Shenzhen, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0788-0344","authenticated-orcid":false,"given":"Bo","family":"Liu","sequence":"additional","affiliation":[{"name":"Shenzhen Baoan Women's and Children\u2019s Hospital, Shenzhen, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5541-6167","authenticated-orcid":false,"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Shenzhen Baoan Women's and Children\u2019s Hospital, Shenzhen, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092211354563000_16.9.e122320.1","unstructured":"World Health Organization . Syphilis. 2025. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/syphilis"},{"key":"2026092211354563000_16.9.e122320.2","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens14111148","article-title":"Resurgent Syphilis Across the Globe: A Public Health Perspective on Bridging Surveillance and Strategy","volume":"14","author":"Espinoza","year":"2025","journal-title":"Pathogens"},{"key":"2026092211354563000_16.9.e122320.3","unstructured":"National Health Commission of the People\u2019s Republic of China . National notifiable infectious diseases surveillance data 2021. 2022. 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Global guideline on criteria and processes for validation: elimination of mother-to-child transmission of hiv, syphilis and hepatitis b virus. 2022. 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Protocol for prevention of mother-to-child transmission of HIV, syphilis and hepatitis B (2020 edition). 2020. Available: https:\/\/www.nhc.gov.cn\/fys\/c100078\/202011\/0d0d2478617f401694e89788a948b394.shtml"},{"key":"2026092211354563000_16.9.e122320.21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.5009"},{"key":"2026092211354563000_16.9.e122320.22","doi-asserted-by":"crossref","first-page":"67","DOI":"10.24920\/003903","article-title":"Eliminating Mother-to-Child Transmission of Syphilis: Chinese Practice before and during COVID-19 Pandemics","volume":"37","author":"Du","year":"2022","journal-title":"Chin Med Sci J"},{"key":"2026092211354563000_16.9.e122320.23","unstructured":"CCTV.com . National health commission: china\u2019s maternal testing rates for hiv, syphilis and hepatitis b exceed 99%. 2024. 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ISOSS Syphilis Report (for pregnancies between 1 April 2022 and 31 March 2023). London: GOV.UK; 2025. 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Updated recommendations for the treatment of neisseria gonorrhoeae, chlamydia trachomatis, and treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services. 2024. 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