(P17) PRENATAL PROVIDER AND MATERNAL PERSPECTIVES ON THE RISE OF CONGENITAL SYPHILIS: A QUALITATIVE STUDY

Background:
The nation has seen a precipitous rise in congenital syphilis (CS) over the last decade. Our study aimed to understand the perspectives of prenatal providers and mothers who delivered infants with CS to gain further insight into factors related to the rise in CS.

Methods:
From Chicago, IL, USA, we recruited prenatal providers to participate in semi-structured interviews about their perspectives on the rise of CS. Mothers who delivered infants with CS were also invited to discuss their prenatal and obstetric care, syphilis education, and psychosocial factors related to their diagnosis. Thematic qualitative analyses were performed.

Results:
10 providers and 5 mothers were interviewed. The majority of providers mentioned observed insufficient penicillin uptake. The most common barriers to care and successful treatment of CS that were cited include transportation, sustained communication, missed appointments, gaps in patient understanding or knowledge around congenital syphilis contraction and treatment, limited availability of clinic appointment time slots, appointment burden for patients, and stigma related to the CS diagnosis. Most providers attribute additional factors related to this including longstanding emphasis on HIV for perinatal transmission, decreases in STI testing and treatment during the COVID-19 pandemic, less funding for STI clinics, changes in screening guidelines over the years, and increasing migrant and refugee populations who are seen in clinics. Similar themes were found among the mothers including barriers to care related to transportation, childcare, various forms of stigma, other life stressors, understanding of the disease process, and recognition of the significance of the potential impact on the fetus.

Conclusion:
Transportation, stigma, appointment burden, health literacy, and communication between patients and providers were identified as potential contributors to the rise of CS by healthcare providers and mothers. These findings reflect significant gaps in adequate prenatal care and could help explain some of the factors leading to the rise in preventable disease.