Practice Title: POWER: Prevention and Outreach to Women at Elevated Risk of Syphilis to Address Congenital Syphilis
Department: Los Angeles County Department of Public Health
Size: Large (Population of 500,000+ people)
State: California
Summary of Practice:
As the most populous county in the United States, Los Angeles County (LAC) is home to an estimated 9,861,224 residents as of 2022. The County’s urban, suburban and rural communities span over 4,000 square miles and comprise 88 incorporated cities and approximately 140 unincorporated areas. LAC is among the most ethnically and economically diverse regions in the nation with immigrants making up over a third of the County’s population. An estimated 69,144 Angelenos are homeless on any given night and over 14,000 inmates are housed in county jails - the largest jail system in the U.S., leading to a large population of individuals cycling in and out of the jail system daily. Mortality is perpetuated by methamphetamine and fentanyl overdoses, co-occurring epidemics, and social inequities. Social inequities (beyond those impacting health care access and quality, including but not limited to economic stability, education access and quality, neighborhood safety and built environment, and social and community factors) have influenced the rise in sexually transmitted diseases (STD) over the last decade.
Syphilis rates in LAC are rising at levels not seen in over 30 years, with increases most stark for women, with a 750% increase since 2012. In 2021, LAC had 123 infants who were diagnosed with congenital syphilis (CS) and 18 syphilitic stillbirths. To effectively prevent and eliminate CS, the LAC Department of Public Health (Public Health) needs a strengthened and collaborative effort to prevent new CS cases. Suboptimal syphilis screening among people who could become pregnant, particularly those not receiving regular health care services, has been identified as a key contributor to congenital syphilis.
Public Health’s Division of HIV and STD Programs (DHSP) has set out to identify non-traditional syphilis screening strategies to test and treat women of reproductive age who may have undiagnosed syphilis. In this manner, any case of syphilis detected could be considered a case of CS averted. DHSP has conducted key informant interviews with colleagues from a variety of community-based organizations (CBO) to women with substance use disorder and/or women experiencing mental health challenges and/or women experiencing homelessness, including providers who deliver harm reduction services and homeless healthcare services. As a result of this focused effort, DHSP has developed three screening strategies: 1) a CBO-DPH Paired Model, whereby Public Heath staff provide HIV and STD testing in the field in partnership with a CBO with strong ties with the target population, 2) a CBO-DPH Transition Model, where Public Health staff work with CBOs to integrate HIV and STD testing within their service delivery setting with the goal to train and transition testing responsibilities to CBO staff, and; 3) a Homeless Healthcare Provider Model, where Public Health staff provide technical assistance, training, support and testing supplies to homeless healthcare providers to incorporate testing into their care model.
For the CBO-DPH Paired Model, Public Health partnered with a CBO providing advocacy and harm reduction services to cis-gender women of reproductive age engaging in transactional sex and their partners in an area of downtown Los Angeles known for sex work. As part of this partnership, regular outreach events were coordinated to provide low barrier STD and HIV testing and treatment to existing clients and other individuals experiencing homelessness in the surrounding area. All services provided have used field-based approaches, including mobile units, instrumented lab tests, point of care tests, case management, incentives, provider evaluation and treatment services, when indicated.
For the CBO-DPH Transition Model, Public Health identified a CBO whose leadership team expressed interest in integrating rapid HIV and STD testing into their syringe support program (SSP), that provides harm reduction services to persons who inject or smoke drugs, namely opiates and methamphetamine. While the organization already offered HIV testing as part of other programing targeting men who have sex with men and transgender persons; the organization, needed assistance integrating testing for HIV and STD into their SSP program that served a separate clientele. Public Health provided technical assistance, training, and quality assurance protocols to the organization’s leadership team; both entities agreed that it would be beneficial for Public Health to perform testing at the SSP, have the SSP staff shadow the LAC DPH staff, and then eventually transition testing responsibility to the SSP staff with some Public Health oversight during a defined transition period.
For the Homeless Health Care (HHC) Provider Model, Public Health partnered with a local County operated homeless healthcare program. The HHC team received temporary COVID-19 funding to support vaccination efforts among people experiencing homelessness (PEH). Public Health DHSP appealed to the HHC provider to integrate HIV/STD testing into their services. During the course of four months, the HHC provider conducted several health outreach events to sheltered and unsheltered PEH, integrating HIV and STD testing and treatment alongside vaccination, showers, harm reduction services (safe injection and smoking supplies, Narcan, and contingency management), wound care kits, safer sex kits, and general health care services.
The success of these models demonstrated how critical it is to work in partnership with community-based service providers trusted by the target population; the opportunities for integrating HIV and STD testing within existing service models, and the potential for high yield services targeted to sub-populations at elevated risk for infection. Public Health DHSP continues to explore opportunities with additional CBOs and HHCs to further expand syphilis testing among women at elevated risk for infection.
Website: http://ph.lacounty.gov/dhsp/
POWER: Prevention and Outreach to Women at Elevated Risk of Syphilis to Address Congenital Syphilis
Category
HIV, STI, and Viral Hepatitis
Description