P2B236: Expanding Syphilis Response with Small Hospital-based Public Health Department on Navajo Nation

Background: Syphilis and Congenital syphilis cases are increasing rapidly across the country. In the Western Agency of the Navajo Nation we have seen a similar rise in cases. In the Tuba City Service Area between 2019 and 2021 there was a 500% increase in syphilis cases. Managing and following syphilis results and cases has been a challenge for a small hospital-based public health department. We have assembled a multi-disciplinary team to review and follow these cases, identify risk factors, and develop interventions.

Methods: Starting in 2022, a team composed of multidisciplinary healthcare providers, public health technicians, public health nurses, and Navajo Nation, County and State public health representatives meets virtually once a week to review new syphilis laboratory results. Weekly reports are generated from the laboratory database with all positive syphilis tests in the past week. During calls, each result is reviewed in the context of accompanying information from the Electronic Medical Record. Syphilis staging, treatment guidelines and coordination of treatment and follow-up are discussed, and appropriate parties are assigned to locate and communicate with patients.

Results: From January through November 2022, 406 positive syphilis tests have been identified in our local laboratory. Of these, 158 were identified as new syphilis cases and were staged and referred for treatment and follow-up testing as needed. Of these new cases, 15 were cases of syphilis in pregnancy. With rising cases, we have increased access to testing and expanded treatment options to include home visits with a provider. Additional efforts to identify high-risk populations and develop messaging for early prenatal care and frequent syphilis testing are under way in hopes of decreasing the number of infants with congenital syphilis.

Conclusion: Rising syphilis and congenital syphilis cases are a large and growing burden on small health care facilities and public health departments around the country. A multidisciplinary approach to identify cases, determine appropriate treatment, and coordinate treatment and follow-up have helped to strategically manage the large increase syphilis cases in our service area. Ongoing efforts are underway to inform the community about rising syphilis cases and the recommendation for annual testing, and to increase access to syphilis testing and treatment.