The primary goal of this intervention is to decrease congenital syphilis (CS) via provision of prenatal care to those at highest epidemiologic risk for syphilis. A statewide analysis found CS is associated with homelessness, methamphetamine use and living in the Central Valley. However, when adjusted for prenatal care, these associations were no longer significant. Thus, accessible prenatal care for those who are unstably housed and/or using methamphetamine likely mitigates CS risks posed by these social determinants of health. The Pregnancy Connections clinic was developed and launched with the Family Medicine department of San Joaquin General Hospital. Pregnancy Connections is an open-access prenatal clinic serving pregnant people for the purpose of CS reduction. This clinic serves pregnant persons who meet any of the following criteria: prior or current syphilis diagnosis; unstable housing or unhoused state; substance use disorder (not including marijuana).

Thus far, of 52 eligible patients referred to PConn, 27 (51%) have enrolled in its prenatal care. Of those enrolled, 13 (42%) were diagnosed with syphilis during pregnancy, 12 of whom received adequate treatment. 21 patients (77%) have delivered thus far.

Patient utilization of supportive services has been quite high (e.g. UberHealth rides and case management) as has overall patient satisfaction with the Pregnancy Connections clinic. For instance, one patient expressed that our expertise was “life-changing” for her family unit; another clinical complex patient reported that intensive case management and transportation services afforded her stability, allowing her to ultimately achieve sobriety and retain custody of her child after delivery.

This clinic was formed with input from key informant interviews of people who would be eligible for the clinic based (e.g, people who were unstably housed and had been pregnant in the past). Their perspectives were invaluable when determining what and how services were offered.

Dedicated support from a medical assistant and/or case manager is essential, as well as the ability for patients to communicate via a specified telephone number, including via text message. Public Health collaboration is another essential component, expanding patient retention via Clinical Disease Investigators. Finally, it is important to develop intentional partnerships with community-based organizations that serve people who may be eligible for the intervention to build a bidirectional referral network.