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Poster Session II: STI Interventions

(P130) LOS ANGELES COUNTY DPH CREATES A NO COST DELIVERY PROGRAM FOR PRIORITY POPULATIONS: A RESPONSE TO THE NATIONAL BICILLIN L-A SHORTAGE

Wednesday, September 18, 2024
4:15 PM - 5:15 PM EST

    Primary Author(s)

  • Monica Darlene Munoz, BSN, MPH, PHN

    Manger-Clinical Guidance & Nursing
    Los Angeles County Department of Public Health
    Los Angeles, California, United States

    • Co-Author(s)(s)

  • Sonali Kulkarni, MD, MPH

    Medical Director, Division of HIV and STD Programs
    Los Angeles County Department of Public Health
    Los Angeles, California, United States

  • Shobita Rajagopalan, MD, MS, MPH (she/her/hers)

    Senior Physician Internal Medicine/Infectious Disease, Associate Medical Director/STD Clinical Chief
    Division of HIV and STD Programs, Los Angeles County Department of Public Health
    Los Angeles, California, United States

Background:
Syphilis in persons of reproductive potential (PRP) continued to experience a dramatic resurgence in Los Angeles County (LAC), the incidence of congenital syphilis (CS) increased 17-fold from 8 cases in 2013 to 136 cases 2022. Treating a pregnant person for syphilis also treats their fetus and treating non-pregnant PRP can prevent future CS sequalae should she become pregnant. In late April 2023, the FDA announced a benzathine penicillin G (Bicillin L-A) shortage; lasting until the fourth quarter of 2024. Bicillin L-A is the only recommended treatment option for syphilis for persons infected or exposed during pregnancy. Healthcare providers (HCPs) should prioritize Bicillin L-A to protect neonates exposed to syphilis in utero. In response to shortage and surge in syphilis the LAC Division of HIV & STD Programs (DHSP) created a no cost Bicillin Delivery Program (BDP).

Methods:
LAC-DPH/DHSP can help providers obtain no cost Bicillin utilizing the US Federal Government’s 340b pricing program. LAC providers call the DPH Consultation Line to initiate the BDP. This program ensures Bicillin L-A to: 1) All pregnant LAC residents diagnosed with syphilis and 2) PRP and their partners. To qualify for BDP: 1) Provider must not carry Bicillin at their clinic, 2) Provider/patient cannot afford the cost of medication(average cost/injection $621.15) and 3) Provider is willing to treat if provided with medication. Public Health Nurses deliver medication to clinic, provide education, and complete required documentation.

Results:
Since BDP inception, 383 Bicillin L-A injections have been deployed free of cost to LAC medical providers/clinics. Preliminary surveillance for 2023 shows a 9-10% decline in CS, 123 cases in 2023 compared to 136 cases in 2022.

Conclusion:
The ongoing Bicillin-LA shortage poses significant challenges to addressing syphilis in pregnancy and CS when the epidemic is at its peak. The BDP model demonstrates promising results to treat pregnant and non-pregnant PRP.