Battling Congenital Syphilis in Louisiana Chaquetta Johnson, DNP , - PowerPoint PPT Presentation

Battling Congenital Syphilis in Louisiana Chaquetta Johnson, DNP , MPH, APRN, WHNP-BC Deputy Director, S TD/ HIV Program Louisiana Department of Health - Office of Public Health

Louisiana

Louisiana

2016 S TD S urveillance S tate Rankings 2 nd –  Chlamydia – 31,727 cases, 679.3 per 100,000 2 nd –  Gonorrhea – 10,782 cases, 230.8 per 100,000  P&S Syphilis – 1 st – 750 cases , 16.1 per 100,000  Congenital syphilis – 1 st – 48 cases – 74.4 per 100,000

Congenital S yphilis in Louisiana 2016

Congenital S yphilis Louisiana 2007-2016 60 50 Number of Cases 40 30 54 48 46 20 40 37 33 32 24 10 18 11 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year of Diagnosis

Congenital S yphilis Rates Louisiana and the US , 2007-2016  In 2015, Louisiana reported 54 CS cases  In 2015, Louisiana ranked 1 st in the US for CS case rates (83.9 cases per 100,000 live births); 6x the national rate of 12.4 cases per 100,000 live births oddslot cases  In 2016, Louisiana had 48 CS  Louisiana’s CS case rate decreased to 75.2 cases per 100,000 live births in 2016

Louisiana Department of Health Office of Public Health (OPH) regions

Congenital S yphilis Cases Geographic Distribution by OPH regions, 2016

Congenital S yphilis in Louisiana, 2016  Every Public Health Region reported at least one case of congenital syphilis  59% of CS cases occurred in three regions: Regions 2 (Baton Rouge), Region 7 (S hreveport), and Region 8 (Monroe)  90% of mothers were Black  69% of mothers were <25 years of age at the time of delivery  27% of mothers had no or untimely prenatal care (prenatal care initiated at least 2 months before delivery)  17% who did receive timely prenatal care did not have timely syphilis screening (at least 45 days before delivery)

Battling Congenital S yphilis in Louisiana  In 2016, Louisiana S TD/ HIV Program implemented the S TD/ HIV Reduction S trategy  Direct Care S ervice  Increased S TD screening and testing statewide  Patient Awareness & Education  Louisiana Health Hub: www.louisianahealthhub.org  Community Awareness & Engagement  Each OPH region has an operational S TD/ HIV Regional Task Force  Congenital S yphilis Reduction was a top priority for the S tate, the Program and the Reduction S trategy

Battling Congenital S yphilis in Louisiana Congenital S yphilis Case Review  Implemented a formal CS Regional Case Review process  Init iat ed as a part of S TD AAPPS act ivit ies:  As a high morbidit y st at e: “ Assess congenit al syphilis cases t o det ermine t he epidemiological and healt h care f act ors associat ed wit h t he cases t o inf orm int ervent ions”  Case Review Teams are comprised of Cent ral Office st aff, OPH Regional Medical Team leadership, DIS Regional st aff  Case reviews were init ially held mont hly; now host ed quart erly t o increase t imeliness of feedback and opport unit ies for int ervent ion

Louisiana Congenital S yphilis Regional Case Review  Parish of residence  Prenatal Care  Delivering Hospital/ Provider yphilis testing in 1 st & 3 rd  S Trimester  S tage of Disease  Treatment – Facility, Adequacy, S tart Dates  Infant – DOB, testing, treatment (if available)  Partner services - Treatment/ follow-up

Louisiana Congenital S yphilis Case Review Findings  Lack of repeat/ third trimester testing of syphilis among pregnant women  Inadequate treatment for women diagnosed with syphilis during pregnancy  Late/ no initiation of prenatal care  Lack of patient/ partner education regarding S TIs and safe sex practices during pregnancy to prevent late pregnancy infection/ re-infection  Need for increased communication between Regional DIS staff and Regional Medical Directors during case investigations for pregnant women diagnosed with syphilis

HIV/Syphilis During Pregnancy Reporting Form Testing • Act 459 Third Trimester HIV and S yphilis Testing Law • Louisiana law requires opt -out t est ing for all women during 1st t rimest er of • pregnancy, 1st prenat al visit in 3rd t rimest er and at delivery (if t est ing/ st at us is not not ed in her medical chart s) New HIV/Syphilis During Pregnancy Report Form • Intended to improve reporting of HIV and syphilis during pregnancy • Previously only used Adult Case Report Form • S treamlines the reporting process • Online: http:/ / dhh.louisiana.gov/ index.cfm/ page/ 1019 • Opportunity to identify high risk pregnancies before mother gives birth • Improves prevention outreach efforts • Gives more information to the S TD/ HIV Program about the mother’s needs, • if any  Through our DIS and Linkage to Care Coordinators, S HP has the ability to connect a women who has unmet needs to the care and services necessary in order to have a healthy pregnancy and reduce MTCT of HIV or syphilis

Battling Congenital S yphilis in Louisiana  Tripled syphilis screening across t he st at e using rapid syphilis t est ing t echnology  In 2016, 93.5% of primary and secondary syphilis cases were t reat ed wit hin 14 days of specimen collect ion at Parish Healt h Unit s (PHUs); an increase from 78.6% in 2015  Provider Alert Let t ers were widely dist ribut ed t o physician and nursing organizat ions t hrough email list serves and license renewal not ices  S hared Regional geocoded maps wit h t he Regional Medical Direct ors/ Regional Task Forces depict ing primary and secondary syphilis infect ions t o assist wit h t arget ed educat ion and int ervent ion effort s

Congenital S yphilis in Louisiana What’s Next?  Enhanced Congenital S yphilis Response grant  Expand our CS case review teams to include representation from Medicaid and the OPH Bureau of Family Health  Develop a CS case management model that will be piloted in two high morbidity regions (Baton Rouge and S hreveport)  Host two Congenital S yphilis conferences that will focus on clinical and community partnership to reduce congenital syphilis  Closer collaboration with Medicaid to advocate for third trimester testing (Medicaid Quality Committee & OB S ubcommittee)  Collaboration with community partners focused on improving birth outcomes to incorporate congenital syphilis prevention in their messaging and efforts (Tulane University & March of Dimes)

Congenital S yphilis Louisiana 2007-2016 60 50 Number of Cases 40 30 54 48 46 20 40 37 33 32 24 10 18 11 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year of Diagnosis

Goal = Happy, Healthy Babies in Louisiana!

Acknowledgements  Ashley Hoover, S HP Perinatal S urveillance S upervisor  Jessica Fridge, S HP S urveillance Manager  Congenital S yphilis Case Review Team members

Chaquetta Johnson, DNP , MPH, APRN, WHNP-BC Deputy Director, S TD/ HIV Program Louisiana Department of Health/ Office of Public Health Chaquetta.Johnson@ la.gov