(PL14) RAPID SYPHILIS TESTING IN INCARCERATED SETTINGS IN LOS ANGELES COUNTY (LAC): IDENTIFYING AND TREATING NEW AND PREVIOUS INFECTIONS

Background:
Rates of early syphilis in females in LAC has increased nearly 7-fold from 2013 to 2022, and in 2017 approximately 46% of congenital syphilis cases were born to mothers with a history of arrest or incarceration in the LAC jail system. We describe the experience of conducting rapid syphilis testing (RST) for incarcerated women of reproductive age on identifying new early syphilis cases and treating previous syphilis cases from 2022-2023.

Methods:
The LAC Department of Public Health, Division of HIV and STD Programs (DHSP) staff provided voluntary RST to women of reproductive age at Century Regional Detention Facility (CRDF). Those with a reactive test were either offered a confirmatory blood test on-site or referred to DHSP or another agency for confirmatory testing. Data was matched with DHSP syphilis surveillance data to determine patient syphilis history.

Results:
From 2022-2023, 1,159 women were screened using RST, with 149 (12.9%) testing reactive. Of those, 79 (44.1%) completed a confirmatory test resulting in eight (10.1%) new syphilis infections (seven completed treatment) and 67 (84.8%) late syphilis/unknown duration infections, of which 43 (64.2%) completed treatment. Over 70% of late syphilis/unknown duration infections identified had no prior treatment history reported. The remaining 70 testing reactive after RST either refused a confirmatory test or were released prior to confirmatory testing. Surveillance confirmed that 30 (42.9%) of those had reactive a confirmatory test reported to DHSP within 30 days, and 24 (80.0%) were sufficiently treated.

Conclusion:
Providing RST to women of reproductive age in custody is a low-resource, high-yield process that can identify those needing additional support to address syphilis infections. This screening pinpoints those who need prenatal or reproductive healthcare referrals, prompts confirmatory testing, and allows for treatment of infections which have not been previously treated, which can help address congenital syphilis outcomes.