Emergency Department Outreach for HIV Prevention Increases Syphilis Treatment

Syphilis incidence continues to rise in the U.S., disproportionately impacting women, pregnantindividuals, people who inject drugs (PWID), and men who have sex with men (MSM). Manypatients affected by syphilis also meet criteria for comprehensive prevention services (CPS) butexperience fragmented follow-up after emergency department (ED) testing. We evaluated theimpact of a multi-modal outreach intervention designed to improve linkage to CPS on the receiptof syphilis treatment in discharged ED patients.

We conducted a pre/post implementation study of the University of Washington FOCUSProgram’s CPS model. Eligible patients were HIV-negative ED patients who screened positivefor syphilis, gonorrhea, or chlamydia, with targeted outreach to pregnant patients, PWID, andMSM. A dedicated Linkage to Care Coordinator (LTCC) used four outreach modalities: (1)EMR/MyChart messaging, (2) phone calls, (3) LTCC–primary care provider (PCP) coordination,and (4) patient-initiated PCP engagement. Outcomes included successful linkage to syphilistreatment, stratified by outreach type and vulnerability status. Barriers such as inaccuratecontact information, language needs, provider pushback, intimate partner violence concerns,and incarceration interruptions were recorded.

In 2023 before the introduction of the CPS program (pre-intervention), 5% of syphilis-positiveED patients received treatment. In 2024, following CPS implementation, treatment linkage increased to 13%. Among the first 85 patients who were successfully linked. EMR produced the highest linkage proportion (32/85; 37.6%), followed by phone (22/85;25.9%), LTCC-facilitated PCP coordination (16/85; 18.8%), and patient-driven PCP follow-up(15/85; 17.6%). There were significant improvements in linkage of non-White populations between the pre (21.4%) and post (42.8%, p< 0.05) implementation phase.

A structured, multi-modal ED-based outreach model significantly improved linkage to syphilis treatment among PrEP-eligible and high-vulnerability patients. EMR patient-portal messaging was the highest-yield modality, suggesting an efficient, scalable strategy for reaching marginalized populations with inconsistent phone access. This approach strengthens STI prevention, enhances equity, and highlights the ED as a critical touchpoint for infectious disease control.