(P437) Implementation of policy into practice: Prenatal syphilis screening policies in Texas

Background: Congenital syphilis (CS) can lead to adverse outcomes, including birth defects and stillbirth. CS rates have increased 650% from 2016-2019 in Texas, but early detection by screening for syphilis infections at prenatal care visits can reduce maternal and neonatal morbidity. In the US, states regulate prenatal syphilis screening requirements through legislation. In 2019, Texas modified state-level policies to require screening at delivery, a third timepoint to address the significant increases in CS. However, rates continued to increase after this policy modification, suggesting a gap in translation of policy into practice. This study explores the determinants influencing the implementation of the modified prenatal syphilis screening policies into clinical care in Texas.

Methods: Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted in-depth interviews with Certified Nurse Midwives (CNMs). CNMs were recruited through social media, email invitations, and flyers. Interested providers completed a screening survey and provided contact information to schedule an interview via Zoom. Interviews were recorded, transcribed, and analyzed using a priori and emergent codes. Thematic analysis was conducted utilizing a priori codes from CFIR constructs and emergent codes.

Results: Participants represented a variety of settings, including outpatient hospitals, community clinics, and private practice. CNMs at clinics that implemented the policy change into their practice reported the change was implemented and disseminated by directors and leadership who may lack clinical expertise. Contextual and structural factors within the inner clinic setting were commonly discussed as influential in implementation. These included perceptions of the policy change as unnecessary given low syphilis prevalence among clinic patients, disconnects in communication within the practice, and balancing clinic requirements with personal standards of care.

Conclusion: Most participants were not aware of the state-level prenatal screening policy change and lack knowledge of the evidence supporting the policy modification. By identifying the structural and contextual determinants that differ by practice setting, results can be used to develop targeted policy implementation strategies and modify practice behavior. Prenatal syphilis policies are amended in response to public health needs and systematic implementation strategies and rapid dissemination and implementation methods can be beneficial in improving translation into clinical practice.