Routine Syphilis Screening in Later Pregnancy-Implementation in Victoria, Australia.

Abstract

Introduction: Syphilis cases are increasing among women globally, including in Victoria, Australia, leading to a re-emergence in congenital syphilis cases. Timely detection and treatment of syphilis before delivery can prevent mother-to- child transmission. While early trimester screening for syphilis is established in Australia, recent cases of congenital syphilis highlight the need for rescreening pregnant women at later stages of pregnancy. Aim(s): This project aims to implement routine syphilis screening during the 28-week antenatal clinic visit across various healthcare services in Victoria. Additionally, we aim to develop a cost-effective implementation package supporting practice changes in antenatal settings. Method(s): The implementation package was developed through a system analysis of seven metropolitan and rural antenatal services. A hybrid implementation framework identified contextual and behavioural factors guiding the integration of routine syphilis screening into existing clinical workflows, considering variations in pathology ordering and electronic records. The Consolidated Framework for Implementation Research provided a deep contextual analysis to guide the implementation process. Result(s): The implementation package was rolled out in December 2022 across antenatal services providing care to 23,000 pregnant persons per year and comprised four core elements: (1) clinical guidelines recommending routine syphilis serology at the 28-week visit; (2) automated pathology ordering; (3) clinician reminders in clinical records and (4) training and resources for clinicians, including videos and pamphlets. Discussion(s): Implementing change in diverse healthcare settings requires a comprehensive analysis of existing systems and resources. The resulting implementation package holds promise for addressing the preventable epidemic of congenital syphilis in other healthcare settings.