Think Syphilis: Evaluating Testing and Treatment Services for Pregnant Women Attending Prenatal Care in Maricopa County, Arizona

Abstract

Background: Arizona has had one of the highest rates of congenital syphilis in the nation in recent years. The purpose of this study was to evaluate compliance with mandated 3 time-point syphilis testing for pregnant women attending prenatal care, describe access to benzathine penicillin G (BPG) treatment, and assess receipt and use of Think Syphilis campaign materials in Maricopa County, AZ.

Methods: A facility-level cross-sectional survey was performed among prenatal care providers and clinical staff in 2022 to 2023. Responses from individual participants were applied to their facilities, including respective satellite offices within their corporations.

Results: Responses from 42 distinct health care facilities were included, representing 104 outpatient obstetrician-gynecologist clinical settings. These facilities represented 232 delivering providers accounting for 33,196 live births, approximately 68.0% of all reported live births in Maricopa County for 2021. Of the 42, 41 (97.6%) reported use of syphilis screening policies for pregnant women. Reported compliance with performing prenatal syphilis testing was 78.6% (33 of 42) for syphilis at first prenatal care visit and 73.8% (31 of 42) during the third trimester. Among providers with first-hand knowledge of hospital-based screening practices, 76.5% (13 of 17) reported syphilis screening at delivery. Only 11.9% (5 of 42) reported on-site clinic-based administration of BPG; 71.4% (30 of 42) reported referring syphilis patients to an external site for treatment with BPG. Barriers to on-site treatment included cost and perception of syphilis as rare. The Maricopa County STI Clinic was the most reported treatment referral site by 90.5% (19 of 21) of respondents. Regarding the Think Syphilis campaign, 21.4% (9 of 42) confirmed receipt of campaign materials, and of these 77.8% (7 of 9) shared materials with office staff.

Conclusions: Reported performance of 3 time point syphilis testing for pregnant women attending prenatal care in Maricopa County is substantial. However, clinic-based barriers to on-site BPG administration exist. This survey afforded an opportunity to educate providers and clinic staff on maternal syphilis testing and treatment using the Think Syphilis campaign.

Figure 1:. Hierarchal diagram of Maricopa County live birth coverage represented by survey results

Assuming satellite offices follow the same practices for syphilis screening and treatment as the direct facility respondent interviewed, survey responses represented providers and facilities that accounted for 70% (33,916/50,245) of the Maricopa County live births in 2021 representing 232 delivering providers, and 104 individual Ob/Gyn facilities. Sixty complete survey responses were obtained. Following selection of single surveys from unique facilities, 42 were utilized for analysis with each completed survey representing a unique facility.