CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: A routine, opt-out, syphilis screening program for all ED patients under age 65 was implemented in the ED of a large, urban, tertiary care hospital in Chicago. Prior to that, testing occurred at clinician discretion following the standard of care. This study retrospectively reviewed all ED encounters among pregnant people for the two-year periods before and after implementation of the screening program. Syphilis cases were defined by a combination of positive serology, rapid plasma regain (RPR) titers, and clinical history derived from chart review. Descriptive statistics were used to evaluate changes in screening and diagnosis rates, as well as demographic and clinical trends. Results: A total of 9,165 ED encounters involving pregnant patients were identified. In the two years before the intervention, 296 of 4,764 (6.2%) encounters included testing for syphilis, which increased almost eight-fold after the intervention, to 2,307 of 4,401 (52.4%) encounters. There were 3 (1.1% of screened population) syphilis cases identified before the intervention, which quintupled to 16 (0.7%) after the intervention. Screened patients were predominantly non-Hispanic Black (94.3% before, 92.1% after) and had public insurance (72.3% before, 72.5% after), reflecting local demographics. Notably, of all pregnant patients diagnosed with syphilis through the screening program, only 5 (31.2%) were tested for other sexually transmitted infections (STIs), 7 (43.8%) presented to the ED with abdominal or pelvic pain, and none presented with symptoms of an STI. Conclusion: This study found that a non-targeted screening program dramatically increased syphilis screening and diagnosis rates among pregnant patients, the majority of whom did not present with concern for STI. Implementing routine ED syphilis screening in high prevalence communities will be key to addressing the syphilis epidemic, eradicating congenital syphilis, and addressing major health care disparities. 1161 Syphilis Screening and Incident Infection Rates in HIV Treatment and HIV PrEP Programs in BC, Canada Junine Toy 1 , Paul Sereda 1 , Raquel M. Espinoza 1 , Erin Ready 2 , Viviane Dias Lima 1 , Kate Salters 1 , Peter Phillips 2 , Rolando Barrios 1 , Julio Montaner 1 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2 St Paul's Hospital, Vancouver, Canada Background: In Canada, syphilis continues to affect gay, bisexual and other men who have sex with men (gbMSM), and increasingly heterosexual persons and youth. We characterize syphilis testing and incidence rates among British Columbia (BC) HIV PrEP and HIV Drug Treatment Program (DTP) clients. Methods: Adults ≥18 years enrolled in BC PrEP and DTP with program contact (lab test, drug dispensed) between 1-Jan-2018 to 31-Dec-2022 were included (followed to 30-Jun-2023). Demographics, HIV risk group, syphilis testing rates (per person-year (PY)), using a reverse-sequence algorithm with treponemal EIA, and incidence rates (per 100PY) were estimated. Results: Overall, 20,033 clients [median (Q1-Q3) age 44 (33-57) years; 90% cis-men, 9% cis-women, 1% trans-women, 0.3% trans-men, 0.3% other genders were included [PrEP (n=10,422), DTP (n=9557), and PrEP/DTP (n=54), the latter including clients switching from PrEP to DTP after HIV infection]. 95% of clients had ≥1 syphilis test [PrEP (n=10,240), DTP (n=8643) and PrEP/ DTP (n=54)], for which the testing rates were 3.40, 2.75, and 3.13 per PY, and incidence rates were 5.03, 3.78, and 14.73 cases per 100PY, respectively. See Figure. Among PrEP clients, those reporting prior bacterial rectal STI or syphilis as their PrEP eligibility criteria, had the highest incident syphilis rate (10.84 per 100PY), followed by those with baseline HIRI-MSM score ≥10 plus ≥1 other HIV risk factor (8.44 per 100PY). High syphilis rate (8.19 per 100PY) among clients with baseline HIRI score ≥25 was observed. Youth (under 30), and those aged 30-39 had higher syphilis rates in DTP than in PrEP (8.45 and 7.09 per per 100PY, respectively) vs. (4.98 and 5.36 per 100PY, respectively). gbMSM in the DTP had similar syphilis rate to the PrEP program overall (5.68 vs. 5.03 per 100PY), as well as similar screening rates (3.15 vs 3.40 per PY). For heterosexual clients, and persons who have ever injected drugs in DTP, syphilis rates were 1.33 and 1.13 per 100PY, respectively. For cis-women with ≥1 syphilis test (n=1470/1748, 84%), testing rate was 1.97 per PY and incidence rate 0.96 per 100PY across programs. Conclusion: High syphilis rates were observed in PrEP clients reporting baseline STI, multiple HIV risk factors, and HIRI-MSM score ≥25. This was similar for gbMSM and younger persons living with HIV. Notably, PrEP clients who subsequently acquired HIV had very high incident syphilis rates. These findings will help inform future public health interventions, such as doxyPEP

1159 Gaps in the Prevention of Mother-to-Child Transmission of Syphilis in South Africa, 2020-2022 Alex de Voux 1 , Wellington Maruma 2 , Mabore Morifi 2 , Modiehi Maduma 2 , Joy Ebonwu 2 , Sithembile Dlamini Nqeteko 3 , Landon Myer 1 , Tendesayi Kufa 2 1 University of Cape Town, Cape Town, South Africa, 2 National Institute for Communicable Diseases, Johannesburg, South Africa, 3 World Health Organization, Geneva, Switzerland Background: Congenital syphilis (CS)-vertical transmission of syphilis during pregnancy-can lead to adverse fetal outcomes including stillbirth and neonatal death. In South Africa (SA), CS is notifiable, however, notifications have been low leading to concerns of underreporting. In addition, infant data accompanying CS surveillance reports (CNFs) are minimal limiting evaluation of missed prevention opportunities. Since January 2022, CNFs were supplemented with CS-specific case investigation forms (CIFs) with additional maternal and infant clinical history. We reviewed CS CNFs and CIFs reported in SA from January 2020–June 2022 to identify gaps in the CS prevention cascade. Methods: We reviewed CNFs prospectively collected during January 2020–June 2022 and matched them to submitted CIFs to review infant and maternal clinical history and determine the proportion of pregnant women (PW) (1) enrolled in antenatal care (ANC), (2) tested for syphilis during pregnancy, and (3) treated for syphilis, amongst those diagnosed, ≥28 days before delivery. Results: During January 2020–June 2022 938 CNFs and 667 CIFs were submitted. Record linkage provided a final dataset of 343 matched CNF-CIF pairs, 37% (343/938) of total CNFs. Among 343 matched CNF-CIF pairs, 56% (n=195) of pregnant women (PW) had ≥1 ANC visit documented, 87% (n=298) were tested for syphilis and of these 88% (n=261) tested positive and 70% (n=210) were treated. Of those tested during pregnancy, 40% (n=120) were tested ≥28 days before delivery. Limiting to PW with ≥1 ANC visit documented (n=195), 98% (n=191) were tested, and of these 86% (n=164) tested positive and 78% (n=152) were treated. Overall, 28% of treated PW received the first dose ≥28 days before delivery, while 18% of PW treated <28 days before delivery tested positive for syphilis ≥28 days before delivery. estimated by the World Health Organization (86 per 100,00 live births) for SA in 2022. Evaluation of the CS prevention cascade relied on supplemental infant and maternal information and was limited to less than half of total cases reported. PW with early engagement in ANC had improved syphilis testing and treatment outcomes, but testing earlier in pregnancy did not always guarantee timely treatment highlighting need to identify barriers to timely treatment following a positive syphilis test during pregnancy. 1160 Routine Emergency Department Screening Increases Syphilis Diagnosis Among Pregnant Patients Kimberly A Stanford , Eleanor Friedman, Joseph Mason, Aniruddha Hazra, John Schneider University of Chicago, Chicago, IL, USA Background: Considering the recent surge in congenital syphilis, novel means of reaching vulnerable populations for testing and treatment are needed. The CDC recently suggested screening outside traditional prenatal care settings might be an effective strategy. As the primary source of healthcare for many communities with limited access to care, visits to the emergency department (ED) may represent a crucial opportunity for syphilis detection and congenital syphilis prevention. Conclusion: Total SA CS cases reported during January 2020-June 2022 translated to a crude CS rate (36 per 100,000 live births) half the CS rate

Poster Abstracts

CROI 2024 378