Integrated response to address a resurgent syphilis epidemic in a rural American Indian community, Whiteriver, Arizona, January 2022 – June 2023

Abstract

Background The United States has seen a significant rise in syphilis over the past twenty years with a disparate impact on American Indian communities. We conducted a thorough review of the local epidemiology that guided an innovative response to curb the epidemic. Methods We analyzed syphilis data from a hospital in rural Arizona that serves an American Indian population of over 18,000. Testing data was extracted from 2017-2023 with detailed chart reviews of all reactive results since January 2022. Descriptive and comparative statistics were computed using parametric and non-parametric methods where appropriate. Results Among 5,888 tested persons, 555 (9.4%) had reactive results and 277 (4.7%) represented new infections. Among new cases, 151 (54.5%) were female and 55 (19.9%) were reinfections. The annualized incidence rate was 10.0 cases per 1000 persons with peak annualized incidence among women ages 30-34 years of 22.6 infections per 1000 persons. During the observation period and after the implementation of programmatic changes in June 2022, there were statistically significant reductions in median time to treatment (-80%), test positivity (-70%), infections (-60%) and no congenital syphilis cases during the observation period. Conclusions We observed significantly elevated syphilis rates in AI/AN persons compared to the general population. Strategic implementation of new policies and practices led to a measurable and meaningful improvement in several epidemic variables and our experience may serve as a model to other communities.