(PL18) LESSONS LEARNED FROM RAPID HIV AND SYPHILIS TESTING IN A SYRINGE SERVICES PROGRAM IN LOS ANGELES COUNTY

Background:
Methamphetamine use among early syphilis cases in women who have sex with men and men who have sex with women has increased substantially across the county since 2012; in Los Angeles County (LAC) approximately 1 in every 5 people who inject drugs has had syphilis.

Methods:
LAC Department of Public Health partnered with a syringe services program (SSP) to provide rapid HIV and syphilis testing to individuals reporting methamphetamine use. Persons with reactive HIV tests were referred to care, and those with confirmatory laboratory syphilis serologies were offered treatment. Cross referencing of DPH syphilis records was conducted retrospectively.

Results:
Between July and December 2023, approximately 450 unique individuals were served at the SSP.  Of those, 316 agreed to rapid HIV testing and 214 agreed to rapid syphilis testing (RST).  Of those tested for HIV, 11 (3%) were reactive. Six were newly diagnosed and 5 had been previously diagnosed; all were successfully linked to care.  Of those tested for syphilis, 34 (15%) were reactive for treponemal antibodies using RST. Thirty percent refused to a blood draw for confirmatory testing. Over half (n=19) of the 34 reactive cases had a history of previous syphilis infection, with 8 reinfected or inadequately treated. Seven of the 8 were lost to follow-up (LTFU) and one received treatment. Of the 15 individuals with no prior syphilis history, 7 were diagnosed with syphilis; six were LTFU and 1 received treatment.

Conclusion:
SSP clients have a high prevalence of syphilis and LTFU pending laboratory confirmatory syphilis testing was common. Collaboration with public health for real-time record searches would allow agencies to provide immediate treatment to those with previous untreated syphilis. Agencies could offer treatment to syphilis naïve patients based on a reactive RST alone if the client refused confirmatory testing or are at risk for LTFU.