Madeline Flanagan, program manager for the Public Health Follow-up Program in Austin Public Health's communicable-disease unit, told the Austin-Travis County Public Health Commission that targeted initiatives conducted from February 2024 through January 2025 reduced congenital syphilis cases and expanded treatment options for people of childbearing capacity.

Flanagan described disease intervention specialists (DIS) as "frontline public health detectives" who locate infections, perform partner services and connect people to testing and treatment. She said the program investigated 1,600 new syphilis and HIV cases in the prior year and pursued more than 1,100 people for syphilis-related partner services.

Flanagan said Austin-Travis County instituted two primary changes to address congenital syphilis: (1) closer, continuous monitoring of pregnant people with positive syphilis labs throughout pregnancy (rather than ending follow-up after initial treatment or inability to locate), and (2) a retrospective outreach initiative that sought people of childbearing capacity who were inadequately treated for syphilis between 2019 and early 2024.

Key figures presented to the commission included: 116 individuals had syphilis investigations initiated due to positive syphilis labs during pregnancy in the February 2024'January 2025 period; 47 of those were syphilis cases and 69 did not meet case criteria (biologic false positives, prior diagnoses, or insufficient lab criteria). The presenter reported that 100 people diagnosed from 2019 to 2024 were identified in a retrospective review as still requiring treatment.

To reduce barriers to treatment, APH piloted a field-based medical-provider model: DIS located and pursued 33 retrospective cases and six additional high-risk untreated individuals, for a total of 39 individuals pursued during an intensive 4-week outreach period. Of the 39 individuals targeted, APH reported 44% received adequate treatment during the pilot, with nearly 59% of treated individuals receiving medication in the field from a mobile provider. Eleven people who had been previously lost to follow-up or had refused care were successfully treated as part of the initiative.

Flanagan emphasized that earlier screening and treatment prior to conception are critical. She told the commission that in Texas syphilis screening during pregnancy is legally required at the first prenatal visit, during the third trimester and at delivery (the presenter attributed the three-test standard to Texas requirements). Flanagan cautioned that the data she presented were provisional and had not completed CDC reconciliation for 2024.

Program outcomes presented included: a reported 7% decrease in congenital syphilis cases compared with a 42% increase the prior year; a reported 100% treatment adequacy for pregnant people in Austin-Travis County (although not always 30 days prior to delivery); and 93% treatment adequacy for people of childbearing capacity compared with 74% in the rest of Texas (per the presenter). Flanagan said the program had increased monthly case conferencing for pregnancy cases, prioritized follow-up for people of childbearing capacity, and expanded provider education in the community.

Flanagan and commissioners discussed barriers to treatment such as housing instability, limited phone access, transportation challenges, clinic hours and competing life priorities. Commissioners and the health authority suggested expanding screening in other medical encounters and supporting provider education to modernize testing algorithms. Commissioners asked about using EMS and community health workers (CHWs) for outreach; Flanagan said EMS involvement is used in limited circumstances, and confidentiality concerns can limit some outreach approaches.

Flanagan warned that program gains rely on sustained staffing and funding: she said the follow-up program's work is resource-intensive and that staffing cuts could make the initiatives unsustainable. Commissioners invited APH to return with implementation recommendations and asked whether the commission could be activated to support sustained staffing and provider-education efforts.