Battling Congenital Syphilis in Louisiana · Increased STD screening and testing statewide ......
Transcript of Battling Congenital Syphilis in Louisiana · Increased STD screening and testing statewide ......
Battling Congenital Syphilis in Louisiana
Chaquetta Johnson, DNP, MPH, APRN, WHNP-BC
Deputy Director, STD/HIV Program
Louisiana Department of Health - Office of Public Health
Louisiana
Louisiana
2016 STD Surveillance State Rankings
Chlamydia – 2nd – 31,727 cases, 679.3 per 100,000
Gonorrhea – 2nd – 10,782 cases, 230.8 per 100,000
P&S Syphilis – 1st – 750 cases , 16.1 per 100,000
Congenital syphilis – 1st – 48 cases – 74.4 per 100,000
Congenital Syphilis in Louisiana 2016
Congenital Syphilis Louisiana 2007-2016
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Congenital Syphilis Rates Louisiana and the US, 2007-2016
In 2015, Louisiana reported 54 CS cases
In 2015, Louisiana ranked 1st in the US for CS case rates (83.9 cases per100,000 live births); 6x the national rate of 12.4 cases per 100,000 livebirths
In 2016, Louisiana had 48 CS oddslot cases
Louisiana’s CS case rate decreased to 75.2 cases per 100,000 live births in2016
Louisiana Department of Health Office of Public Health (OPH) regions
Congenital Syphilis Cases Geographic Distribution by OPH regions, 2016
Congenital Syphilis 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 (Shreveport), 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 Syphilis in Louisiana In 2016, Louisiana STD/HIV Program implemented the STD/HIV
Reduction Strategy
Direct Care Service
Increased STD screening and testing statewide
Patient Awareness & Education
Louisiana Health Hub: www.louisianahealthhub.org
Community Awareness & Engagement
Each OPH region has an operational STD/HIV Regional Task Force
Congenital Syphilis Reduction was a top priority for the State, the Program and the Reduction Strategy
Battling Congenital Syphilis in Louisiana Congenital Syphilis Case Review Implemented a formal CS Regional Case Review process
Initiated as a part of STD AAPPS activities: As a high morbidity state: “Assess congenital syphilis cases to determine
the epidemiological and health care factors associated with the cases to inform interventions”
Case Review Teams are comprised of Central Office staff, OPH Regional Medical Team leadership, DIS Regional staff
Case reviews were initially held monthly; now hosted quarterly to increase timeliness of feedback and opportunities for intervention
Louisiana Congenital Syphilis Regional Case Review Parish of residence
Prenatal Care
Delivering Hospital/Provider
Syphilis testing in 1st & 3rd Trimester
Stage of Disease
Treatment – Facility, Adequacy, Start Dates
Infant – DOB, testing, treatment (if available)
Partner services - Treatment/follow-up
Louisiana Congenital Syphilis 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 STIs 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 Syphilis Testing Law
• Louisiana law requires opt-out testing for all women during 1st trimester of pregnancy, 1st prenatal visit in 3rd trimester and at delivery (if testing/status is not noted in her medical charts)
• New HIV/Syphilis During Pregnancy Report Form • Intended to improve reporting of HIV and syphilis during pregnancy • Previously only used Adult Case Report Form • Streamlines 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 STD/HIV Program about the mother’s needs, if any
Through our DIS and Linkage to Care Coordinators, SHP 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 Syphilis in Louisiana Tripled syphilis screening across the state using rapid syphilis
testing technology In 2016, 93.5% of primary and secondary syphilis cases were
treated within 14 days of specimen collection at Parish Health Units (PHUs); an increase from 78.6% in 2015
Provider Alert Letters were widely distributed to physician and nursing organizations through email list serves and license renewal notices
Shared Regional geocoded maps with the Regional Medical Directors/Regional Task Forces depicting primary and secondary syphilis infections to assist with targeted education and intervention efforts
Congenital Syphilis in Louisiana What’s Next?
Enhanced Congenital Syphilis 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 Shreveport)
Host two Congenital Syphilis 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 Subcommittee)
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 Syphilis Louisiana 2007-2016
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46 54
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2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Num
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Year of Diagnosis
Goal = Happy, Healthy Babies in Louisiana!
Acknowledgements
Ashley Hoover, SHP Perinatal Surveillance Supervisor
Jessica Fridge, SHP Surveillance Manager
Congenital Syphilis Case Review Team members
Chaquetta Johnson, DNP, MPH, APRN, WHNP-BC Deputy Director, STD/HIV Program
Louisiana Department of Health/Office of Public Health