Routine, Opt-Out Syphilis Screening for Women in Local Jails – Lessons Learned in Implementation Open Access
Drame, Fanta N. (Summer 2023)
Abstract
Syphilis affects thousands of reproductive-age women each year and leads to adverse pregnancy outcomes. Syphilis rates, more specifically primary and secondary syphilis, across the United States continue to rise, with the largest increase occurring among women, between 2020 and 2021. The primary and secondary syphilis rate among women increased by 53.3%, compared to a 22.9% increase among males. In 2021, there were a total of 2,855 cases of congenital syphilis; 23 of these cases resulted in infant deaths, and 197 cases were stillbirths. Timely testing and treatment can prevent syphilis and congenital syphilis case, but systematic barriers such as institutionalized racism and limited access to health care lead to many missed opportunities in identifying and preventing syphilis. Surveillance data has revealed that the majority of cases are found in non-STD clinics, demonstrating the need to integrate syphilis screening in non-traditional settings. Surveillance data and studies also demonstrated that a history of incarceration or sexual contact with someone who has been incarcerated has an association with syphilis diagnoses. This highlights the opportunity for correctional facilities to serve as a point to disrupt syphilis transmission by providing point-of-care syphilis screening and treatment. To evaluate different mechanisms to expand syphilis screening and treatment services to incarcerated women, we conducted a demonstration project to better understand the implementation of routine, opt-out screening of women in local jails. This project was implemented across three states, ranging from small to large population sizes in both the western and southeastern regions of the US. Local health departments were encouraged to develop a strategic partnership model with a local jail to combat increases in syphilis among women and congenital syphilis. Throughout the project, lessons learned yielded ways of identifying opportunities for addressing challenges. Issues addressed included policy adherence and alignment, data collection and access, screening and treatment protocol alignment, staffing capacity and buy-in, as well as detainee acceptance of the screening. These lessons learned can inform future efforts to implement and optimize routine opt-out syphilis screening in jails to expand access to a segment of a disproportionately affected, vulnerable population and disrupt syphilis transmission and adverse pregnancy outcomes.
Table of Contents
Chapter 1. Literature Review, 1
1.1. The Current Issue of Syphilis and Congenital Syphilis, 1
1.2. Missed Opportunities in Congenital Syphilis Prevention, 2
1.3. Healthcare in Correctional Facilities, 3
1.4. Deliberate Indifference 4
1.5. Syphilis in Correctional Facilities, 5
Public Health Significance, 8
Chapter 2. Introduction, 9
Chapter 3. Methods, 10
3.1. Objective, 10
3.2. Recruitment of Project Sites, 10
3.3. Implementation Protocol, 11
3.4. Data Collection and Analysis, 12
Chapter 4. Results , 15
4.1. Reach, 15
4.2. Effectiveness , 15
4.3. Adoption, 16
4.3.1. Staff Buy-in , 16
4.3.2. Staff Concerns, 17
4.3.3 Inmate Buy-in, 17
4.4. Implementation, 18
4.4.1. Changes in Testing Protocols, 18
4.4.2. Changes in Treatment Protocols, 20
4.4.3. Data Access and Collection, 20
4.5. Maintenance, 20
Chapter 5. Discussion, 24
5.1. Lessons Learned, 24
5.2. Limitations, 27
Chapter 6. Conclusion, 28
About this Master's Thesis
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