Procedimento operacional padrão para o tratamento da sífilis na Atenção Primária à Saúde: rompendo o paradigma da aplicação da benzilpenicilina benzatina

Abstract

Syphilis is a sexually transmitted systemic infection that is curable and exclusive to humans. It is caused by the Treponema pallidum bacterium and can be transmitted through unprotected sexual contact and from mother to baby during pregnancy in cases where the pregnant woman has not received or received inadequate treatment. Primary Health Care (PHC) plays a crucial role in providing comprehensive care to people with syphilis and promotes prevention, diagnosis, treatment, follow-up, and surveillance actions. Since 2016, Brazil has been experiencing a syphilis epidemic, partly due to an increase in testing coverage, a decrease in condom use, and resistance from health professionals to administer benzathine benzylpenicillin in PHC. Given this situation, the objective of this study was to develop and present a Standard Operating Procedure (SOP) to contribute to the adherence and safety of the teams in administering benzathine benzylpenicillin in PHC based on the fragilities identified by professionals. This study was a qualitative action research type and was conducted in a municipality in the 7th Health Region of Rio Grande do Norte (RN). The study universe was the technical teams of PHC and Surveillance, as well as the teams of Basic Health Units (BHUs) that do not administer benzathine benzylpenicillin. Information was collected through the use of focus groups. The Atlas ti. cloud was used for data organization and categorization and content analysis developed by Laurence Bardin was used as the interpretation method. It was possible to organize and group the difficulties faced by professionals in treating syphilis in PHC, relating to the dimensions of health care management. In the professional dimension, the disability of professionals for preparing and administering this medication and taboos related to anaphylactic reactions were highlighted, such as fear of administering the medication to people who have never received it and in situations where the doctor is not present in the BHU. In the organizational dimension, fragilities in the logistics of medicines and supplies were highlighted, as well as the absence of protocols to guide practices and standardize the conduct of teams. In the systemic dimension, fragilities in the structure of BHUs are evidenced by the lack of a procedure room and space for observing users and the absence of basic items for emergency and emergency care. There are also fragilities in health management in supporting BHUs and understanding the role of PHC in the context of Health Care Networks (HCN). The identification of these fragilities contributes to the production of new tactics that can positively impact the intervention actions carried out by PHC teams. In this context, meeting the requirements of the Prefessional Master’s, it was decided to create a SOP whose purpose is to serve as a management and care strategy, since when developed and implemented with duly trained health teams, it helps with decision-making, expands access, and strengthens the care line for people with syphilis.