(P2) PREVENTING CONGENITAL SYPHILIS — FACTORS AFFECTING ACCESS TO PRENATAL CARE IN CLARK COUNTY, NEVADA, 2017–2022

Background:
Nevada ranked eighth in the United States for congenital syphilis (CS) rates in 2022. Lack of prenatal care access and recommended screenings are missed opportunities for CS prevention. We sought to identify factors affecting prenatal care access in Clark County, Nevada, to guide public health action to prevent CS.

Methods:
We analyzed confirmed and probable syphilis cases, based on the Council of State and Territorial Epidemiologists case definition, among pregnant persons reported to the Southern Nevada Health District during 2017–2022 in Clark County, Nevada. Reported prenatal care was collected during standardized interviews. Univariable logistic regression was used to compare odds of not receiving prenatal care among age groups and those who do and do not engage in substance use.

Results:
During 2017–2022, we identified 456 syphilis cases diagnosed among pregnant persons with complete data. Median age was 27 years (range: 16–44 years); substance use was reported by 213 (46.7%) persons and 162 (35.5%) reported transit time >30 minutes to the closest provider. Prenatal care access was not reported by 119 (26.1%) persons. In total, 145 (31.8%) pregnant persons had infants who received a CS diagnosis, of which 84 (57.9%) reported no prenatal care. Pregnant persons with substance use had 2.8 times the odds of not accessing prenatal care, compared with those without (odds ratio [OR]: 2.86; 95% CI 1.85, 4.35). Similarly, persons aged >35 years had higher odds of not accessing prenatal care, compared with those aged <20 years (OR 3.70; 95% CI 1.35, 10.0).

Conclusion:
We found an inverse association between accessing prenatal care and both age and substance use. While preliminary, our findings underscore effects of substance use concerning access to prenatal care, although multivariable analysis will be needed to better understand this relationship. Characterization of specific barriers limiting access to prenatal care can improve this crucial step in CS prevention.