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Pathways to Congenital Syphilis Prevention: A Rapid Qualitative Assessment of Barriers, and the Public Health Response, in Caddo Parish, Louisiana

Kroeger, Karen, A., PhD*; Sangaramoorthy, Thurka, PhD, MPH; Loosier, Penny, S., PhD, MPH*; Schmidt, Rebecca, MPA; Gruber, DeAnn, PhD, LCSW§

Sexually Transmitted Diseases: July 2018 - Volume 45 - Issue 7 - p 442–446
doi: 10.1097/OLQ.0000000000000787
Original Studies

Background Congenital syphilis (CS) disproportionately affects racial and ethnic minority women, especially in the US South. Although CS is relatively easy and inexpensive to prevent through screening and treatment of pregnant women, CS cases have continued to rise and are concentrated in relatively few US counties and states. In 2010, Louisiana had the highest case rate in the country for primary, secondary, and CS, with the highest number of CS cases in northwest Louisiana, where Shreveport is located.

Methods We conducted qualitative interviews with community members (women and frontline providers) living in Caddo Parish to obtain their views about factors that negatively impact CS prevention.

Results Participants described impediments in the pathways for prevention of CS. Lack of sexual and reproductive health education, discontinuities and fragmentation in health care insurance coverage, a dearth of referral points for prenatal care, and difficulty finding prenatal care providers who accept Medicaid can delay timely and adequate care for pregnant women. Participants reported that low reimbursement for necessary injections and difficulty obtaining required medication challenged efforts to screen and treat pregnant women according to guidelines.

Conclusions Although CS is easily prevented, health system and policy obstacles in pathways to CS prevention and care may need remediation at state and local levels.

Congenital syphilis is prevented by timely screening and treatment of women during pregnancy; however, behavioral, structural, and policy barriers may impede pathways to prevention and require remediation at multiple levels.

From the *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA;

Department of Anthropology, University of Maryland, College Park, MD;

Department of Health, Thomas Jefferson Health District, Charlottesville, VA; and

§Bureau of Infectious Diseases, Louisiana Office of Public Health, New Orleans, LA

Acknowledgements: The authors would like to acknowledge Eleanor Fleming who assisted with data collection and analysis for the original report.

Conflict of Interest and Sources of Funding: None declared.

Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.

Correspondence: Karen A Kroeger, PhD, Centers for Disease Control, Atlanta, GA. kakroeger@hotmail.com.

Received for publication October 30, 2017, and accepted December 22, 2017.

© Copyright 2018 American Sexually Transmitted Diseases Association