(PL8) PRENATAL SYPHILIS SCREENING POLICY IMPLEMENTATION IN TEXAS: THE ROLE OF THE INNER SETTING

Background:
Congenital syphilis (CS) can lead to adverse outcomes including birth defects and stillbirth. CS rates in Texas have increased 148% since 2018, but diagnosis through screening at prenatal care visits can reduce neonatal morbidity. In 2019, Texas modified the state-level screening policy to address the CS increases, requiring screening at an additional timepoint. However, gaps remain in the translation of policy into practice. This study examines the inner setting implementation determinants of modified prenatal syphilis screening policies into clinical care in Texas.

Methods:
We conducted in-depth interviews with prenatal providers (CNMs, PAs, NPs, and physicians; n=18) guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted via Zoom, recorded, and transcribed. Thematic analysis was conducted in MAXQDA utilizing a priori CFIR constructs and emergent codes.

Results:
Inner setting facilitators included the learning climate, particularly in clinics with residency or training programs, and strong networks and communication within smaller clinics where providers are active in the implementation process. Barriers included perceptions of the policy change as incompatible given low syphilis prevalence among clinic patients, top-down approaches, and disconnects in communication within the practice, and lack of clinical training among leadership to support implementation.

Conclusion:
By identifying the inner setting determinants associated with translation into care, these findings can guide the development of context-specific policy implementation strategies and modify practice behavior. Syphilis screening policies may continue to be amended in response to public health needs and future work should examine rapid dissemination and implementation approaches to improve translation into practice.