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8 <br />. ;:. , . <br />,'"~ The difficulties encountered in routine partner elicitation of those exposed to or at risk far <br />syphilis in Guilford County prompted DIS to screen at corner hang outs, crack houses, and liquor <br />houses where original patients reported sexual encounters. Clients with previous histories of <br />syphilis who had no current clinical signs of infection but were believed to be at high risk, <br />received preventive benzathine penicillin therapy. This form of "social network" clustering <br />resulted in 38 individuals tested for syphilis with 9 (38%) having positive tests. Although only 4 <br />of the tests were new positives, the remaining S were serofast titers, confirming that high-risk <br />individuals were being reached. <br />A critical component of a R,I.O.T. is the follow up to maintain the decrease in morbidity that has <br />been achieved. In Guilford County,, staff worked to continue relationships with the community <br />and providers which were enhanced or strengthened during the R.I.O.T. The Guilford County <br />agencies continue to meet to discuss problems and have occasional projects together. However, <br />resources are currently insufficient to maintain an active syphilis prevention or elimination <br />campaign beyond usual activities. <br />Following the Guilford RI.O.T., CDC assisted the Section and local health department with. an <br />evaluation of the Guilford syphilis outbreak and a rapid community-based needs assessment to <br />tailor future syphilis prevention and control efforts. The outbreak evaluation revealed a strong <br />relationship between syphilis cases and crack cocaine, whether used by the patient or the se~.-ual <br />contact During 1997, interviewed Guilford syphilis cases claimed an average of 3.2 partners, <br />but were able to provide sufficient information to initiate locating activity for 1.7 partners per <br />case. Given that 38% of cases had traded sex for drugs or money--a dramatic increase from 10°~0 <br />in 1994--the average 3? partners par case is probably understated. Consistent v~~ith disease <br />transmission in a setting ofnumerous--often anonymous--sexual partners, yet low numbers of <br />partners that could be initiated, clustering was found to be an effective technique for identifying <br />infected persons. The same investigation revealed that emergency rooms and ja.iLs, who also have <br />contact with crack users, were not screening for syphilis in the vast majority of cases. Based on <br />more limited information, the Forsyth County and, more recently, Alamance and Orange County <br />syphilis outbreaks appear to be similar in their low proportion of partners with location <br />information and their strong relationship with crack cocaine. During the peak of the Forsyth <br />County outbr°..ak in 199, cases reported an average of 3.5 partners, but provided sufficient <br />information to initiate locating activities for only 2.0 partners per case. Despite currently <br />decreasing numbers of syphilis cases in Forsyth County, an increasing proportion are in persons <br />who have traded sex for drugs or money, from 28% in 1994 to 4I% in 1997. <br />A t..am of f ve staff conducted the rapid community-based needs assessment in Guilford County <br />is Saauary 1998. The goals of the assessment were to: 1) determine points of access for persons <br />ax behavioral risk for syphilis, 2) ascertain culturally appropriaxe and acceptable syphilis <br />prevention messages and strategies, and 3) tailor outreach and screening efforts. The team <br />conducted b4 interview and one focus group with relevant service providers and those perceived <br />to be at behavioral risk for syphilis (key participants). The attached Guilford County Rapid <br />Community Assessment Report, includes the analysis and summary of data obtained from these <br />intervieR~s. Recommendations were developed through a comparison of the provider and key <br />3 <br />