(P21) IMPLEMENTATION OF EMERGENCY DEPARTMENT OPT-OUT AND RAPID POINT-OF-CARE SYPHILIS TESTING PROGRAM FOR PREGNANT PATIENTS

Background:
In Southeastern Texas, 30% of pregnant people who had a newborn with congenital syphilis presented to the Emergency department (ED) during pregnancy and were not tested for syphilis, representing a critical missed opportunity. The objective of this study is to determine if implementation of an opt-out and rapid point of care (POC) testing strategy will improve diagnosis and treatment of maternal syphilis for patients presenting to the ED.

Methods:
This is a prospective study of all pregnant patients presenting to the ED without prenatal care and/or without documented syphilis results at the University of Texas Health Science Center, Houston, TX.  Eligible patients undergo POC testing using the FDA-approved Syphilis Health Check (SHC) POC test and venipuncture for lab-based testing for syphilis at the same visit. Navigators query patients about their satisfaction regarding the SHC POC test and link patients to prenatal care.  Patients who test positive for syphilis by the SHC are offered empiric treatment and partners are offered testing through ED services and/or referred to the health department.

Results:
During the first 2 weeks, 20 patients met inclusion criteria and 1 declined. Nine (47%) were < 25 years old, and 13 (68%) were Non-Hispanic Black. All patients tested negative by the SHC POC test; however, 4 patients did not complete the lab-based syphilis test. The SHC POC result was 100% concordant (n=15) with the lab-based syphilis result.  Nine patients (47%) presented with partners, of which, 9 (33%) requested POC testing. In the satisfaction survey, 100% of patients would recommend the SHC POC test for others, and 80% rated their overall experience as very good or excellent.

Conclusion:
Implementation of a strategy using the SHC POC syphilis test and opt-out testing in the ED for pregnant patients is feasible. Partner interest in SHC POC testing may reduce reinfection.