Background:
As of October 1, 2007, 56 cases of syphilis have been reported among members of the Tohono O'Odham tribe in Arizona compared to 1 case in 2005, and 8 cases in 2006. Demographics and risk factors are different than other syphilis case patients in Arizona, with many of the cases occuring among Native American youth. Managing an outbreak on a rural reservation poses unique challenges and offers many opportunities to collaborate with tribal, local, state, county, and federal partners.

Objective:
1. Describe collaborative outbreak response strategies.
2. Describe the roles of the collaborative partners.
3. Describe outreach activities developed in response to the outbreak.
4. Describe process monitoring of an outbreak on a rural reservation.

Method:
The program has provided support through education, mediation, evaluation, and investigation during the syphilis outbreak via a collaborative effort between all partners. Case management, public awareness, training, outreach, and case investigation activities were conducted.

Result:
Resources and training needs have been identified. Results include increased targeted testing, treatment, interviews, education, and community involvement.

Conclusion:
Collaborative efforts are important in developing an outbreak response strategy. Identification of resources and development of process objectives are vital components of the plan. Ensuring infrastructure is essential in order to respond to an outbreak.

Implications:
The declaration of an outbreak on a rural reservation needs to managed using strong comunication and identifying and developing collaborative relationships with all partners. Leadership in building capacity and offering technical assistance is a priority. It is important to build parnerships and work together collaboratively in order to manage an outbreak.