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

High and increasing syphilis rates among American Indian/Alaska Native communities and particularly among American Indian/Alaska Native women and infants call for immediate interventions to reach and offer syphilis testing to sexually active populations paired with timely treatment.

The Great Plains Tribal Epidemiology Center within the Great Plains Tribal Leaders Health Board partnered with a local nontribal health care facility to offer free community-based syphilis testing in Rapid City, South Dakota, starting in December 2022 through June 2024. Participants received cash incentive cards for undergoing testing for syphilis, human immunodeficiency virus (HIV), and hepatitis C virus.

Fifteen community testing events were conducted. Laboratory-based syphilis testing was performed on 1434 unique individuals with an average age of 38.8 years. Seventy-six people were diagnosed with syphilis that had previously not been identified (prevalence, 5.3% [76 of 1434]; 51 [67.1%]) were female. Treatment was provided to 80.3% of people with syphilis (61 of 76) within an average of 36 days. In total, the 15 events cost $158,019 ($75,000 administrative staff time + $5100 laboratory staff time + $24,009 laboratory tests + $ 53,910 incentives) or $88 per test performed ($158,019 per 1797). The cost to identify a previously unidentified case was $2079 ($158,019 per 76 newly identified infected persons).

This community-based screening event revealed high prevalence of undiagnosed syphilis. Incentives supported community members to access screening services. Collaborations between clinical, tribal, and public health entities to bring diagnosis and treatment services to patients using a community-based approach have clear benefits but need ongoing supportive resources to be maintained.