Gaps in the Congenital Syphilis Prevention Cascade: Qualitative Findings from Kern County, California

Abstract Background. Congenital syphilis is preventable through timely access to prenatal care, syphilis screening and treatment of pregnant women diagnosed as infected. In 2018, California had the second highest number of congenital syphilis cases in the United States (U.S.), a nearly 2-fold increase in cases since 2014. This study assessed gaps in preventing congenital syphilis in the high morbidity region of Kern County, California. Methods. Between May 2018 and January 2019, we conducted five focus group discussions with pregnant/postpartum women and ten semi-structured interviews with prenatal care providers in Kern County. Focus group and interview data were recorded, transcribed, and analyzed to identify emergent themes pertaining to facilitators and barriers at each step (prenatal care, syphilis screening and treatment) in the congenital syphilis prevention cascade.Results. Gaps in congenital syphilis prevention discussed in focus group discussions with pregnant/postpartum women were related to limited prenatal care access, social-, economic-, and cultural-barriers, and substance use and co-occurring intimate partner/domestic violence. The gaps identified from interviews with prenatal care providers included social economic vulnerabilities of pregnant women and stigma and shame around the vulnerabilities, distrust in medical system, prenatal substance use, limited prenatal substance use disorder treatment facilities, and inadequate provider training on context-specific congenital syphilis management strategies. Gaps in partner notification, screening and treatment for syphilis were brought up by pregnant/postpartum women and prenatal care providers. Conclusions. Congenital syphilis continues to increase in Kern County and throughout the U.S. In high syphilis morbidity areas, comprehensive and tailored public health approaches addressing setting-specific gaps in prenatal screening and treatment are needed.

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A qualitative assessment of structural barriers to prenatal care and congenital syphilis prevention in Kern County, California

PLoS ONE ◽

10.1371/journal.pone.0249419 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249419

Author(s):

Elaine Y. L. Chan ◽

Carolyn Smullin ◽

Stephanie Clavijo ◽

Melissa Papp-Green ◽

Eunhee Park ◽

...

Keyword(s):

Prenatal Care ◽

Congenital Syphilis ◽

The United States ◽

Qualitative Assessment ◽

Kern County ◽

Care Providers ◽

Structural Barriers ◽

Care Access ◽

Prenatal Care Providers ◽

In Pregnancy

Congenital syphilis is the result of placental transmission from mother to fetus of Treponema pallidum. Although congenital syphilis is preventable through timely treatment, the rate of new infections in the United States (US) has increased each year since 2013, and is increasing at a noticeably greater pace in California (CA). Most research into congenital syphilis has focused on individual psychosocial and behavioral factors that contribute to maternal vulnerability for syphilis. The aim of this study was to evaluate structural barriers to prenatal care access and utilization and congenital syphilis prevention in Kern County, CA. Transcripts from 8 in-depth interviews with prenatal care providers and 5 focus group discussions with 42 pregnant and postpartum persons were examined using thematic analysis. Structural barriers experienced by pregnant and postpartum persons to prenatal care access and utilization included (1) burdens of poverty; (2) stigma around substance use in pregnancy; (3) citizenship status; (4) lack of healthcare coverage; (5) low sexual health literacy; and (6) gender inequality Structural barriers experienced by prenatal care providers in congenital syphilis prevention included (1) limited guidance on clinical management of syphilis in pregnancy; (2) decay in public health infrastructure; and (3) inadequate support for managing patients’ social comorbidities. The response to congenital syphilis prevention will require an examination of the complex context of social determinants of health in which persons diagnosed with syphilis live in.

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166. Congenital Syphilis in Minnesota, 2016-2020

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.166 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S100-S100

Author(s):

Nicholas Lehnertz ◽

Khalid Bo-Subait ◽

Candy Hadsall ◽

Cheryl Barber ◽

Allison LaPointe ◽

...

Keyword(s):

Substance Use ◽

Prenatal Care ◽

Alaska Native ◽

Maternal Age ◽

Congenital Syphilis ◽

Clinical Signs ◽

First Trimester ◽

Case Definition ◽

Care Providers ◽

Missed Opportunities

Abstract Background Nationally, cases of congenital syphilis (CS) have increased over the past 5 years. We reviewed CS cases in Minnesota from 2016-2020. Methods All cases of syphilis, including CS, are reported to the Minnesota Department of Health (MDH), including accompanying data on maternal age, baby’s sex, race, test results, maternal stage and treatment of mother and child. Medical records and case interviews were reviewed; the 2018 national case definition was used to classify cases. Results During 2016-2020, there were 47 CS cases from 45 mothers, peaking in 2020 at a rate of 3.2/10,000 live births. 43 (91.5%) cases of CS had no clinical signs, 1 (2.1%) CS case was inadequately treated, and there were 2 deaths. The median maternal age was 28 (IQR 9, range 18-38). 13 (28.9%) identified as Black, non-Hispanic, 13 (28.9%) as American Indian/Alaska Native (AI/AN), 9 (20.0%) as White, non-Hispanic, 3 (6.7%) as Hispanic, 2 (4.4%) as Asian/Pacific Islander, and 5 (11.1%) Other/Unknown. Twenty-four (51.1%) cases occurred in the Minneapolis/St. Paul metropolitan area. 2 (4.4%) cases were primary, 1 (2.2%) was secondary, while 18 (40.0%) maternal cases were staged as early non-primary, non-secondary (ENPNS) and 24 (53.3%) were late unknown duration. 14 (31.1%) of mothers had their initial prenatal visit in the first trimester, 6 (13.3%) in the 2nd trimester, 11 (24.4%) in the 3rd, and 14 (31.1%) unknown. None of the maternal cases were HIV+, 2 were identified as positive for hepatitis C. 18 (40.0%) mothers had no or limited prenatal care, 21 (46.7%) had inadequate treatment for syphilis, and 18 (40.0%) had inadequate maternal testing. No cases reported substance use, but one case had a positive substance screen at delivery, and case interviews also documented a role of substance use and home instability in several other cases. Conclusion Case rates of CS are the highest ever seen in MN. There is disproportionate impact in persons of color and indigenous Minnesotans. Lack of access to prenatal care, missed opportunities for testing, and incomplete or insufficient treatment were found in maternal cases. More work needs to be done with communities at risk and with prenatal care providers to ensure adequate testing, identification and treatment for syphilis in women of child-bearing age. Disclosures All Authors: No reported disclosures

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Should prenatal care providers offer pregnancy options counseling?

BMC Pregnancy and Childbirth ◽

10.1186/s12884-018-2012-x ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Nancy F. Berglas ◽

Valerie Williams ◽

Katrina Mark ◽

Sarah C. M. Roberts

Keyword(s):

Prenatal Care ◽

Care Providers ◽

Prenatal Care Providers

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Lessons from prenatal care provider-based recruitment into the National Children’s Study

Pediatric Reports ◽

10.4081/pr.2015.6056 ◽

2015 ◽

Vol 7 (3) ◽

Cited By ~ 1

Author(s):

James M. Robbins ◽

Melissa D. Bridges ◽

Elizabeth M. Childers ◽

Roseanne M. Harris ◽

Pearl A. McElfish

Keyword(s):

Prenatal Care ◽

Care Providers ◽

Recruitment Method ◽

Equivalent Number ◽

Prenatal Care Providers ◽

Status Number ◽

Public Clinics ◽

Benton County ◽

Birth Records ◽

Successes And Challenges

In response to recruitment difficulties experienced by the National Children’s Study, alternatives to the door-to-door recruitment method were pilot tested. This report describes outcomes, successes, and challenges of recruiting women through prenatal care providers in Benton County, Arkansas, USA. Eligible women residing in 14 randomly selected geographic segments were recruited. Data were collected during pregnancy, at birth, and at 3, 6, 9, 12, 18, and 24 months <em>postpartum</em>. Participants were compared to non-enrolled eligible women through birth records. Of 6402 attempts to screen for address eligibility, 468 patients were potentially eligible. Of 221 eligible women approached to participate, 151 (68%) enrolled in the 21-year study. Enrolled women were similar to non-enrolled women in age, marital status, number of prenatal care visits, and gestational age and birth weight of the newborn. Women enrolled from public clinics were more likely to be Hispanic, lower educated, younger and unmarried than those enrolled from private clinics. Sampling geographic areas from historical birth records failed to produce expected equivalent number of births across segments. Enrollment of pregnant women from prenatal care providers was successful.

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