Exploring Barriers, Facilitators, and Strategies for the Etiological Management of Sexually Transmitted Infections in Brazil: A Qualitative Study Using the Consolidated Framework for Implementation Research (CFIR)
Pâmela Cristina Gaspar, Ximena Pamela Díaz Bermúdez, Maria Luiza Bazzo, Angelica Espinosa Miranda, Adele Schwartz BenzakenBackground:
In Brazil, syndromic management remains the standard approach for male urethral discharge despite the growing need for etiological diagnosis. This study explored barriers, facilitators, and implementation strategies for adopting the etiological approach using the Consolidated Framework for Implementation Research (CFIR).
Methods:
A qualitative study was conducted through semi-structured online interviews with health professionals. Interview transcripts were analyzed deductively using the CFIR Codebook and inductively to identify emerging themes.
Results:
From March to April 2023, 15 professionals from all Brazilian regions were interviewed: five clinicians, five laboratory professionals, and five public health managers. Major barriers for implementing the etiological approach included limited systematic epidemiological data, the absence of rapid immunochromatographic STI tests, limited workforce capacity, and high staff turnover. Key facilitators were timely diagnosis and treatment of asymptomatic infections, targeted therapy based on pathogen identification, and antimicrobial resistance surveillance through biological sample collection. Proposed strategies involved phased introduction, with both approaches initially coexisting: syndromic treatment for symptomatic cases with sample collection to identify the causative agent, discussion of results during follow-up consultations, and screening of asymptomatic cases. Additionally, interviewees recommended mandatory STI notification for standardized data generation, awareness raising, and public policy planning. They also emphasized the need for national meetings on STIs beyond syphilis, HIV, and viral hepatitis.
Conclusions:
Although the syndromic approach remains necessary in Brazil, health professionals demonstrated readiness to implement the etiological approach and identified practical strategies to support its integration into STI prevention and control programs.