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Although global syphilis rates have declined, the prevalence of undiagnosed and untreated infections remains high in low- and middle-income countries. In Uganda, national clinical guidelines recommend syphilis screening and treatment at the first antenatal care (ANC) visit, yet coverage remains suboptimal, contributing to ongoing perinatal transmission. As part of a multiple-method research project, this qualitative study explored provider perspectives on barriers to antenatal syphilis screening and treatment. We conducted in-depth interviews with 20 ANC providers at six public health facilities in two districts serving diverse communities. Using a descriptive qualitative approach and thematic analysis, we identified four interrelated barriers to effective service delivery: (1) stockouts of test kits and benzathine penicillin that disrupt care; (2) limited access to formal training and continuing education, reducing provider confidence in diagnosis and treatment; (3) misalignment between clinical guidelines and routine practice, leading to missed screening opportunities; and (4) low male partner engagement, increasing risk of reinfection. Addressing these barriers through health systems strengthening\u2014including improved supply chain monitoring, universal provider training, supportive supervision, and community-informed strategies for partner engagement\u2014is critical to reducing perinatal syphilis transmission and advancing Uganda\u2019s progress toward congenital syphilis elimination.<\/jats:p>","DOI":"10.1177\/23333936251375457","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T05:15:26Z","timestamp":1759468526000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Barriers to Routine Antenatal Syphilis Screening in Uganda: Provider Perspectives and Practices"],"prefix":"10.1177","volume":"12","author":[{"given":"Natalie","family":"Saham","sequence":"first","affiliation":[{"name":"University of California, Los Angeles, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda P.","family":"Miller","sequence":"additional","affiliation":[{"name":"San Diego State University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Mugamba","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6140-8394","authenticated-orcid":false,"given":"Taylor","family":"Thomas","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bashir","family":"Magada","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriane","family":"Wynn","sequence":"additional","affiliation":[{"name":"University of California, San Diego, La Jolla, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Ddaaki","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Kyasanku","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Bulamba","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9912-2272","authenticated-orcid":false,"given":"Vitalis O.","family":"Olwa","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Nkale","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Kigozi","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Nalugoda","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace N.","family":"Kigozi","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Daama","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertrude","family":"Nakigozi","sequence":"additional","affiliation":[{"name":"Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9957-1932","authenticated-orcid":false,"given":"Jennifer A.","family":"Wagman","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"key":"e_1_3_4_2_1","doi-asserted-by":"crossref","unstructured":"Althabe F. 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