Incentivized Community-Based Syphilis Screening: Uptake, Yield, and Cost

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Community Health Interventions

Background:

• Syphilis rates are alarmingly high and increasing among American Indian/Alaska Native (AI/AN) communities, especially affecting women and infants.
• Urgent interventions are needed to provide syphilis testing and timely treatment to sexually active AI/AN populations.

Purpose of the Study:

• To implement and evaluate a community-based syphilis screening program in Rapid City, South Dakota.
• To assess the prevalence of undiagnosed syphilis and the effectiveness of incentives in a target population.

Main Methods:

• A partnership between the Great Plains Tribal Epidemiology Center and a local healthcare facility offered free community-based syphilis, HIV, and HCV testing from December 2022 to June 2024.
• Participants received cash incentives for undergoing testing.
• Fifteen testing events were conducted, with 1434 unique individuals tested.

Main Results:

• A syphilis prevalence of 5.3% (76/1434) was identified among previously undiagnosed individuals, with 67.1% being female.
• Treatment was provided to 80.3% of those diagnosed with syphilis within an average of 36 days.
• The cost per test was $88, and the cost to identify a new case was $2,079.

Conclusions:

• Community-based screening effectively identified a high prevalence of undiagnosed syphilis.
• Incentives played a crucial role in encouraging community member participation in screening services.
• Collaborative, community-centered approaches are beneficial for syphilis diagnosis and treatment but require sustained resources.