{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:05:21Z","timestamp":1784099121260,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Reprod. Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In Uganda, spatial distribution of syphilis varies by age, gender, and region. Identifying clusters (subsets of administrative subdivisions) with high syphilis prevalence could boost efforts to eliminate mother-to-child transmission of syphilis. We examined spatial variations and clustering of syphilis prevalence among pregnant young women aged 18\u201335 years in Central Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed secondary data from a randomised trial that evaluated the effectiveness of three antenatal syphilis partner notification approaches (NCT02262390). This study analysed clustering of syphilis prevalence by administrative division in Kampala and Wakiso districts, using Moran's I tests and Local Indicator of Spatial Association (LISA). We used Kulldorff Spatial-Scan Poisson model to detect syphilis clustering and classified divisions into high- or low-prevalence (HP\/LP) syphilis clusters based on 95% statistical significance. We estimated prevalence ratios for sociodemographic and bio-behavioural HIV risk factors associated with residence in HP divisions using modified Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 422 women diagnosed with syphilis, 26 (6%) had HIV and syphilis. Median age was 26 years (IQR 24\u201329). Most (314, 74%) were in monogamous marriages, and half (50%) had attained secondary education. Syphilis prevalence clustering was negatively associated with residence in HP divisions among women in polygamous marriages [adjusted prevalence ratio (APR)\u2009=\u20090.64; 95%: 0.47\u20130.88], those with an unplanned pregnancy (APR\u2009=\u20090.78; 95% CI: 0.64\u20130.93), and who had HIV testing &amp;gt;3 months prior (APR\u2009=\u20090.83, 95% CI: 0.72\u20130.95). Syphilis prevalence was significantly higher in 3\/12 clusters: Kasangati Town Council [Relative Risk (RR)\u2009=\u20092.79,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001], Kawempe (RR\u2009=\u20092.52,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001), and Nabweru (RR\u2009=\u20091.95,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0002), and lower in one cluster\u2013Kyengera Town Council (RR\u2009=\u20090.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001). Notably, no significant clustering was detected among women with HIV (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). Random patterns of syphilis prevalence were detected across all divisions (Moran's I\u2009=\u20090.08,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.19). However, some neighbouring divisions had similar prevalence: Kawempe (1.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) and Nabweru (0.54,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045). LISA analysis confirmed high syphilis prevalence in northern divisions (Kawempe and Nabweru;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). By contrast, Central Region had neighbouring low and high prevalence divisions (Kawempe and Central;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Syphilis prevalence was similar within neighbouring divisions, but highest in Kasangati Town Council and Kawempe. Integrating spatial analysis in routine surveillance will enable detection of clusters where interventions can be targeted to eliminate congenital syphilis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frph.2026.1829745","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:09:26Z","timestamp":1784095766000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Syphilis clustering among young pregnant women (18\u201335 years) in Kampala and Wakiso districts, Uganda"],"prefix":"10.3389","volume":"8","author":[{"given":"Rogers","family":"Nsubuga","sequence":"first","affiliation":[{"name":"Research Department, Infectious Diseases Institute, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy R.","family":"Muwonge","sequence":"additional","affiliation":[{"name":"Research Department, Infectious Diseases Institute, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Mujugira","sequence":"additional","affiliation":[{"name":"Research Department, Infectious Diseases Institute, Makerere University","place":["Kampala, Uganda"]},{"name":"Department of Global Health, University of Washington","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Castelnuvo","sequence":"additional","affiliation":[{"name":"Research Department, Infectious Diseases Institute, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith","family":"Nakku-Joloba","sequence":"additional","affiliation":[{"name":"School of Public Health, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalind","family":"Parkes-Ratanshi","sequence":"additional","affiliation":[{"name":"Research Department, Infectious Diseases Institute, Makerere University","place":["Kampala, Uganda"]},{"name":"Centre for Public Health, Queens University","place":["Belfast, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukari C.","family":"Manabe","sequence":"additional","affiliation":[{"name":"Research Department, Infectious Diseases Institute, Makerere University","place":["Kampala, Uganda"]},{"name":"Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes N.","family":"Kiragga","sequence":"additional","affiliation":[{"name":"Research Department, Infectious Diseases Institute, Makerere University","place":["Kampala, Uganda"]},{"name":"African Population and Health Research Centre","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e1413","DOI":"10.1016\/S2214-109X(24)00234-1","article-title":"Prevalence of syphilis among adults and adolescents in five sub-Saharan African countries: findings from population-based HIV impact assessment surveys","volume":"12","author":"Farahani","year":"2024","journal-title":"Lancet Glob Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1107931","DOI":"10.3389\/frph.2023.1107931","article-title":"The association between adverse pregnancy outcomes and non-viral genital pathogens among women living in sub-Saharan Africa: a systematic review","volume":"5","author":"Gamberini","year":"2023","journal-title":"Front Reprod Health"},{"key":"B3","volume-title":"Women and HIV: A Spotlight on Adolescent Girls and Young Women","year":"2019"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e34","DOI":"10.1097\/QAI.0000000000003340","article-title":"New HIV infections among key populations and their partners in 2010 and 2022, by world region: a multisources estimation","volume":"95","author":"Korenromp","year":"2024","journal-title":"JAIDS J Acquir Immune Defic Syndr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0257321","DOI":"10.1371\/journal.pone.0257321","article-title":"Sexual-risk behaviours and HIV and syphilis prevalence among in- and out-of-school adolescent girls and young women in Uganda: a cross-sectional study","volume":"16","author":"Matovu","year":"2021","journal-title":"PLoS One"},{"key":"B6","volume-title":"Uganda Population-based HIV Impact Assessment (UPHIA) 2016-2017: Final Report","year":"2019"},{"key":"B7","year":"2024"},{"key":"B8","first-page":"43","year":"2019"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0216388","DOI":"10.1371\/journal.pone.0216388","article-title":"Geographic information systems, spatial analysis, and HIV in Africa: a scoping review","volume":"14","author":"Boyda","year":"2019","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e69279","DOI":"10.1371\/journal.pone.0069279","article-title":"Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000\u20132006)","volume":"8","author":"Namosha","year":"2013","journal-title":"PLoS One"},{"key":"B11","doi-asserted-by":"publisher","first-page":"21409","DOI":"10.7448\/IAS.20.1.21409","article-title":"Spatial patterns of HIV prevalence and service use in East Zimbabwe: implications for future targeting of interventions","volume":"20","author":"Schaefer","year":"2017","journal-title":"J Int AIDS Soc"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-016-2760-3","article-title":"Spatial analysis of HIV infection and associated individual characteristics in Burundi: indications for effective prevention","volume":"16","author":"Barankanira","year":"2015","journal-title":"BMC Public Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1071\/SH19092","article-title":"Low male partner attendance after syphilis screening in pregnant women leads to worse birth outcomes: the syphilis treatment of partners (STOP) randomised control trial","volume":"17","author":"Parkes-Ratanshi","year":"2020","journal-title":"Sex Health"},{"key":"B14","volume-title":"Consolidated Guidelines for the Prevention and Treatment of HIV and AIDS in Uganda","author":"Moh","year":"2020"},{"key":"B15","author":"Cliff","year":"1973"},{"key":"B16","first-page":"129","year":"2008"},{"key":"B17","year":"2016"},{"key":"B18","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1186\/1471-2458-14-555","article-title":"Spatial analysis of factors associated with HIV infection among young people in Uganda, 2011","volume":"14","author":"Chimoyi","year":"2014","journal-title":"BMC Public Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"9093","DOI":"10.1038\/s41598-017-09464-y","article-title":"Mapping the spatial variability of HIV infection in Sub-Saharan Africa: effective information for localized HIV prevention and control","volume":"7","author":"Cuadros","year":"2017","journal-title":"Sci Rep"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e25635","DOI":"10.1002\/jia2.25635","article-title":"Sexual behaviour change following HIV testing services: a systematic review and meta-analysis","volume":"23","author":"Tiwari","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"B21","doi-asserted-by":"publisher","first-page":"13438","DOI":"10.1038\/s41598-020-70472-6","article-title":"Prevalence of HIV infection and bacteriologically confirmed tuberculosis among individuals found at bars in Kampala slums, Uganda","volume":"10","author":"Baluku","year":"2020","journal-title":"Sci Rep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1645","DOI":"10.1007\/s10461-012-0217-y","article-title":"The disproportionate high risk of HIV infection among the Urban Poor in Sub-Saharan Africa","volume":"17","author":"Magadi","year":"2013","journal-title":"AIDS Behav"},{"key":"B23","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1177\/0956462418804115","article-title":"Relationship between socioeconomic status and risk of sexually transmitted infections in Uganda: multilevel analysis of a nationally representative survey","volume":"30","author":"Anguzu","year":"2019","journal-title":"Int J STD AIDS"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1093\/ije\/dyp148","article-title":"Localized spatial clustering of HIV infections in a widely disseminated rural South African epidemic","volume":"38","author":"Tanser","year":"2009","journal-title":"Int J Epidemiol"},{"key":"B25","volume-title":"Uganda Breau of Statistics 2024: The National Population and Housing Census 2024\u2014final Report\u2014volume 1 (Main)","year":"2024"},{"key":"B26","doi-asserted-by":"publisher","first-page":"7637","DOI":"10.3390\/ijerph18147637","article-title":"Neighborhood-level influences and adolescent health risk behaviors in rural and urban Sub-Saharan Africa: a systematic review","volume":"18","author":"Wiafe","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e25115","DOI":"10.1002\/jia2.25115","article-title":"Population mobility associated with higher risk sexual behaviour in eastern African communities participating in a universal testing and treatment trial","volume":"21","author":"Camlin","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e151","DOI":"10.1016\/S2352-3018(19)30413-8","article-title":"Time, population mobility, and HIV transmission","volume":"7","author":"Cassels","year":"2020","journal-title":"Lancet HIV"},{"key":"B29","doi-asserted-by":"publisher","first-page":"238","DOI":"10.5603\/IMH.2015.0045","article-title":"Travel-related sexually transmitted infections","volume":"66","author":"Korzeniewski","year":"2015","journal-title":"Int Marit Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.puhe.2019.07.002","article-title":"Determinants of maternal healthcare utilization among married adolescents: evidence from 13 Sub-Saharan African countries","volume":"177","author":"Iacoella","year":"2019","journal-title":"Public Health"},{"key":"B31","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1017\/S0021932023000299","article-title":"The practice of polygyny on the utilisation of reproductive health services among married women in Ghana","volume":"56","author":"Kumbeni","year":"2024","journal-title":"J Biosoc Sci"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e0198622","DOI":"10.1371\/journal.pone.0198622","article-title":"Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa","volume":"13","author":"Kanyangarara","year":"2018","journal-title":"PLoS One"},{"key":"B33","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1136\/sextrans-2017-053134","article-title":"Prevalence and treatment outcomes of routine Chlamydia trachomatis, Neisseria gonorrhoeae and trichomonas vaginalis testing during antenatal care, Gaborone, Botswana","volume":"94","author":"Wynn","year":"2018","journal-title":"Sex Transm Infect"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-021-11890-7","article-title":"Mapping geographic clusters of new HIV diagnoses to inform granular-level interventions for HIV epidemic control in western Kenya","volume":"21","author":"Muttai","year":"2021","journal-title":"BMC Public Health"},{"key":"B35","volume-title":"Spatial Mapping of Sexual Network Locations and Utilization of HIV\/STI Preventive Services among Long-distance Truck Drivers Using the Northern Corridor Highway, Kenya","author":"Mutie","year":"2022"}],"container-title":["Frontiers in Reproductive Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1829745\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:09:28Z","timestamp":1784095768000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1829745\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":35,"alternative-id":["10.3389\/frph.2026.1829745"],"URL":"https:\/\/doi.org\/10.3389\/frph.2026.1829745","relation":{},"ISSN":["2673-3153"],"issn-type":[{"value":"2673-3153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"article-number":"1829745"}}