Funded Projects

Community Engagement to Reduce Congenital Syphilis

Project Year

2023

City & State

Minneapolis, Minnesota

Program Name

CATCH Planning

Topic

Native American Child Health

Program Description

"Problem: Nationally rates of primary and secondary syphilis have increased among women of childbearing age (15 - 44 years) over 200% (5.1 per 100,000 in 2017 to 15.6 in 2021). Consequently, congenital syphilis rates from increased over 300% from 24.4 per 100,000 births in 2017 to 74.1 in 2021. American Indian/Alaska Native (AIAN) families are seeing a disproportionate burden of these congenital syphilis cases nationally, with rates 9X than non-Hispanic whites (364 cases vs. 40 cases per 100,000). In Minnesota, we also see a disproportionate increase in syphilis among AIAN populations (86 cases per 100,000 vs 5.2 in non-Hispanic white). In 2021, female cases now make up 48% of new syphilis cases and therefore we see rates of congenital syphilis increasing amongst AIAN populations in Minnesota. The origins of the increased risk for congenital syphilis in AI/AN people demonstrates intersectionality with roots in historical traumas, institutionalized racism, structural and social determinants of health. Statewide public health campaigns have focused on increased public and provider awareness of syphilis outbreak. Despite this public health campaign, the continued increases in congenital syphilis cases among the AIAN community demonstrates that these communications and strategies are not working in AIAN communities. We need an integrated, low-barrier syphilis prevention and treatment services with culturally adapted strategies that are community-based and person-centered, acknowledging social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures. Primary Setting: This project will be in Minneapolis, which is experiencing the highest rates of syphilis in the state (49.7 per 100,000 persons in 2021). AIAN persons composes 1.3% (5,500) of Minneapolis’s population according to 2020 census data although AIAN persons are under-reported. Minneapolis carries a rich cultural history for AIAN population including the birthplace of the American Indian Movement in 1980s. Minneapolis is home for AIAN persons from the 11 federally recognized tribes of the Dakota and Anishanaabe peoples in Minnesota and neighboring states. Number of children affected IIn Minnesota, the rate of congenital syphilis has increased from 3 per 100,000 live births in 2017 to 23.6 per 100,000 in 2021. From 2017 – 2021, there have been 55 cases of congenital syphilis with 19 (35%) occurring in AIAN infants. The rates of early syphilis in women increased drastically over the past 10 years, now with 253 cases reported in 2021 (vs 13 in 2011) with 24%(61) of these cases in Minneapolis and 26%(66) of the cases in AIAN women. This represents only the cases being tested therefore we predict rates may be higher. Project Goal We aim to increase AIAN community leadership and engagement in public health measures to reduce syphilis and congenital syphilis. Engagement encompasses surveying knowledge, perceptions and acceptance of syphilis and congenital syphilis, survey and map community assets, develop community-based goals, propose community-based strategies for reduction of syphilis and congenital syphilis. Proposed Intervention We propose assembly of a community advisory board(CAB) consisting of AIAN community members and community organization representation. After recruitment for participation, the CAB will meet periodically over a year to survey understanding, identify community assets, create goals, and improvise strategies. We anticipate working/hiring with AIAN undergraduate students interested in medicine and community based research. Anticipated Outcomes We anticipate the following outcomes: 1. Increase trust in public health and academic medical systems through relationship building and bidirectional information sharing. 2. Increased AIAN community conversations about syphilis and congenital syphilis outbreak. 3. Identification of Minneapolis AIAN community assets. 4. Identification of community based strategies for prevention of syphilis and congenital syphilis. "

Project Goal

Increase American Indian and Alaska Native (AIAN) community engagement in prevention of syphilis and congenital syphilis.

Project Objective 1

Perform pre/post survey the AIAN community knowledge, acceptance, and perceptions(KAP) of syphilis and congenital syphilis through assembly of a community focus group with goal 10 participants who meet 5 times over 12 months. KAP survey will be performed at first meeting and at the last meeting. Results of the survey will be shared with community focus group, community partners and public health.

Project Objective 2

Identify the AIAN community assets for reducing rates of syphilis and congenital syphilis through guided discussion by SoLaHmo facilitator with the community focus group. Community focus group mapping the identified resources in the 2nd meeting. Project assistants will survey current capacities through site visits.

Project Objective 3

Identify and prioritize AIAN community goals and strategies for syphilis and congenital syphilis reduction. Community focus groups will be led by a SoLaHmo facilitator to promote listening sessions and guided discussion in the 3rd meeting to determine goals. Discussions will be recorded and subsequently transcribed. NIVIVO qualitative research analysis tool will be used to determine themes. Themes of the discussion will be presented back to the community focus group in 4th meeting for consensus and approval. SoLaHmo facilitator will guide discussion to identify strategies for syphilis and congenital syphilis reduction. Discussion will be recorded and transcribed. NVIVO will be used to determine themes and prioritization. Analysis will be shared at 5th meeting for community focus group approval and discussion about implementation.

AAP District

District VI

Institutional Name

University of Minnesota

Contact 1

Alice Lehman