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P22 Rapid Assessment of Factors Related to Persistent High Rates of Congenital Syphilis in Maricopa County, Arizona

Wednesday, March 10, 2010
Pre-Function Lobby & Grand Ballroom D2/E (M4) (Omni Hotel)
Karen Kroeger, PhD1, Melanie Taylor, MD, MPH2, Tom Mickey3, Shruti Ramachandran, MPH, MID1, Penny Loosier, MA, MPH1, Paran Pordell, MPH, CHES4, Samantha Herrington, MPH1 and Fred Bloom, PhD1, 1Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 2Office of HIV, STD, and Hepatitis Services, Arizona Department of Health Services, Phoenix, AZ, 3STD Program, Maricopa County Department of Public Health, Phoenix, AZ, 4Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Background: From 2002-2007, Arizona was ranked among the top 5 states in the US for rates of congenital syphilis (CS). The majority of cases diagnosed during this period were born in Maricopa County to Hispanic women, many of whom were non-citizens. Since 2003, a County Board Order has required syphilis testing of pregnant women at the 1st prenatal visit, during the 3rd trimester, and at delivery; however, high rates of CS persist. 

Objectives: In March 2009, a rapid ethnographic assessment was conducted to better understand community and structural level factors potentially contributing to persistent high rates of CS among Latinas.

Methods: Key informant interviews were conducted with 42 providers from state and local STD/HIV programs, community based organizations and health facilities. Providers were asked their perceptions of STD awareness and risk behaviors, sexual and reproductive health seeking, and barriers to using STD and prenatal care services among Latinos. Data were analyzed using NVivo7. 

Results:Non-English speaking women without legal status were identified as a vulnerable population for congenital syphilis, due to low levels of STD knowledge/awareness, reluctance to use services because of fear of deportation, lack of insurance coverage for prenatal care, and high cost of services for pregnancy and delivery. Some women delay care because they are unaware of the benefits of prenatal care. Screening of pregnant women for syphilis is not routine in ERs.

Conclusions:Continued focus on providers to increase 3rd trimester screening and screening in ERs is warranted. Interventions to reach pregnant women through social institutions and networks also are needed. Activities to address CS require collaboration among state and local health departments and stakeholders. 

Implications for Programs, Policy, and/or Research: Barriers to using prenatal care services exist at community, structural and policy levels, and are contributing to adverse pregnancy outcomes among Latinas in Maricopa County.

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