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

 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 S yphilis in Louisiana 2016

Congenital S yphilis Louisiana 2007-2016

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

Congenital S yphilis 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 per 100,000 live births); 6x the national rate of 12.4 cases per 100,000 live births

 In 2016, Louisiana had 48 CS

• ddslot cases

 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%

• f CS

cases occurred in three regions: Regions 2 (Baton Rouge), Region 7 (S hreveport), and Region 8 (Monroe)



90%

• f mothers were Black



69%

• f mothers were <25 years of age at the time of delivery



27%

• f 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

• pport unit ies for int ervent ion

Louisiana Congenital S yphilis Regional Case Review



Parish of residence



Prenatal Care



Delivering Hospital/ Provider



S yphilis testing in 1st & 3rd 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%

• f 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

37 24 11 33 18 32 40 46 54 48 10 20 30 40 50 60 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Number of Cases 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