Preventing Congenital Syphilis Through Prenatal Care: Qualitative Findings from a Pilot Clinical Program

Congenital syphilis (CS) is highly preventable through prenatal screening and treatment. However, populations disproportionately impacted by prenatal syphilis often face barriers to access, in part due to housing instability and substance use. This study assessed Pregnancy Connections, a pilot program designed to prevent CS by offering comprehensive, patient-centered prenatal care, with added support and comprehensive case management services, for patients experiencing unstable housing and/or substance use.

This qualitative study involved interviews with 3 groups: program staff (n = 13), patients (n = 10), and individuals eligible for the prenatal program but not enrolled (n = 14). Interviews were transcribed and analyzed to identify program successes, challenges, and lessons learned.

Key successes included the provision of respectful and responsive care, reduced barriers to care, improved collaboration and coordination, and improved patient outcomes. The main challenges included difficulties in care coordination within the health center and with external services, suboptimal patient engagement, and limited program outreach and awareness. Lessons learned for future implementation highlighted the urgent need for services and outreach for this vulnerable and often-stigmatized population. Additionally, thoughtful referral systems and incentives, clinic champions, and organizational support were key.

Identifying and developing effective interventions is essential to address this critical public health issue. Providing respectful, patient-centered prenatal care with added support for populations at elevated risk of syphilis is a promising approach.