1175. Low Treatment Rates and Associated Factors Among Pregnant Women with Syphilis in Zambia

Abstract Background Syphilis in pregnancy is common in Africa with prevalence as high as 10%. In high prevalence areas ( > 5%), WHO recommends universal syphilis screening and benzathine penicillin G treatment at the first antenatal clinic (ANC) visit. Implementation barriers include global stock outs and supply chain issues. Our goal was to document treatment rates and factors associated with lack of treatment among pregnant women with syphilis in Zambia. Methods The retrospective cohort study analyzed medical record data from pregnant women who sought care in 10 public ANC clinics in Lusaka, Zambia during 2018-2019 and tested positive for syphilis. Syphilis was diagnosed based on positive RPR testing and treatment was defined as documented penicillin therapy at the same facility. Patient characteristics were compared across treatment status using Wilcoxon Rank Sum Test for continuous variables, and Pearson Chi-Square Test for categorical variables. Simple logistic models with treatment status as the binary outcome were conducted to evaluate potential factors associated with lack of syphilis treatment in pregnancy. A multivariable logistic model was performed and a 2-sided P < 0.05 was accepted as statistically significant. Results Among 28,480 pregnant women screened for syphilis, 5.6% (n=1363) tested positive. Among those with syphilis, median age was 27 years, 21% of women were nulliparous and 43% were living with HIV. Most women (72%) had their initial ANC visit during the 2nd trimester and 96% were screened for syphilis at the first visit. The documented treatment rate was 42% and the only factor associated with lack of treatment was ANC entry in 2019 compared to 2018 (aOR 2.2; 95% CI 1.7-2.8; p < 0.001). (refer to Tables 1-2). Conclusion Syphilis prevalence among pregnant women tested in ANC clinic in Zambia during 2018-2019 was 5.6%. Recommended penicillin treatment was only documented in 42% of cases. No maternal or clinic characteristic was associated with lack of therapy. Calendar year may have been associated with treatment for unclear reasons. Novel approaches to ensure access to universal diagnosis and early treatment of syphilis among pregnant women in Zambia are needed to improve maternal and neonatal outcomes. Disclosures All Authors: No reported disclosures.