Congenital syphilis is the result of placental transmission from mother to fetus of Treponema pallidum. Although congenital syphilis is preventable through timely treatment, the rate of new infections in the United States (US) has increased each year since 2013, and is increasing at a noticeably greater pace in California (CA). Most research into congenital syphilis has focused on individual psychosocial and behavioral factors that contribute to maternal vulnerability for syphilis. The aim of this study was to evaluate structural barriers to prenatal care access and utilization and congenital syphilis prevention in Kern County, CA. Transcripts from 8 in-depth interviews with prenatal care providers and 5 focus group discussions with 42 pregnant and postpartum persons were examined using thematic analysis. Structural barriers experienced by pregnant and postpartum persons to prenatal care access and utilization included (1) burdens of poverty; (2) stigma around substance use in pregnancy; (3) citizenship status; (4) lack of healthcare coverage; (5) low sexual health literacy; and (6) gender inequality Structural barriers experienced by prenatal care providers in congenital syphilis prevention included (1) limited guidance on clinical management of syphilis in pregnancy; (2) decay in public health infrastructure; and (3) inadequate support for managing patients’ social comorbidities. The response to congenital syphilis prevention will require an examination of the complex context of social determinants of health in which persons diagnosed with syphilis live in.

Of Being a First Generation (First Gen) college graduate is an important intersectionality which impacts the lens through which First Gen students learn to become physicians. In this Perspective, we define the First Gen identity and review some of the salient First Gen literature as it applies to the medical school experience. We discuss the conception, design and execution of First Gen initiatives and program development at our medical school as a call to action and model for other institutions to create communities for their First Gen populations, focusing on inclusion and tailored support. We describe the framework through which we envisioned our programming for First Gen medical students, trainees, staff, and faculty at the David Geffen School of Medicine at UCLA.

Background According to the Centers for Disease Control (CDC), PrEP coverage in the United States was approximately 18% in 2018 and 21.9% in California. We predict that PrEP prescription is lower at Harbor-UCLA Medical Center (HUMC) and affiliated clinics within Los Angeles County Department of Health Services. Methods A retrospective chart review of HIV-negative patients with ICD-10 coded diagnoses of sexually transmitted infections (STIs) or high-risk sexual behavior was performed across various medical specialties at HUMC and affiliated clinics in 2018. Documentation of sexual behavior risk reduction counseling, PrEP discussion and prescription was reviewed from electronic medical records for each encounter. Descriptive statistics and analysis were completed in STATA Version 16.1, StataCorp LLC. Results The sample included 250 individual patients, all with indications for PrEP. Of those, 47.2% identified as Latinx and 27.2% Black. Table 1 shows 74% of patients identified as heterosexual whereas 9.2% identified as gay, and 4.4% bisexual. Of the 250 individual patients, 87 (34.8%) returned for a 2nd visit, 35 (14.0%) for a third, and 9 (3.6%) for a 4th visit, for a total of 381 encounters. Of the total encounters, 49.3% had sexual behavior risk reduction counseling, 7.3% had discussions about PrEP with their provider, and only 2.1% were newly prescribed PrEP (Table 2). Of the 2.1% new PrEP prescriptions, 1.8% were prescribed by family medicine providers with no new prescriptions by OB/GYN or acute care providers. Only 25% of new PrEP prescriptions were female patients. A positive test for an STI occurred in 45.1% of total encounters while high risk sexual behavior was identified in 54.9% of encounters (Table 3). Table 1: First Encounter Demographics (N=250 Individual Patients) Table 2: Primary Outcomes by Specialty (N=381 Total Encounters) Table 3: Sexually Transmitted Infections Frequency (N=381 Total Encounters) Conclusion Our findings demonstrate that the percent of individuals newly prescribed PrEP (2.1%) at HUMC and affiliated clinics is less than that reported nationally and in California. This suggests that municipal health systems fall short in PrEP usage, notably for structurally vulnerable populations such as racial minorities as well as heterosexual females. Ending racial/ethnic disparities in HIV and in PrEP coverage not only requires educating specialty providers on PrEP, but also addressing structural racism and identifying structural barriers to care in vulnerable communities. Disclosures All Authors: No reported disclosures