DNP Scholarly Projects

Abstract

Background and Rationale

Congenital syphilis in Tennessee rose 227% from 2017-2021, despite being more than 90% preventable with timely diagnosis and treatment. Women of childbearing age entering correctional facilities represent a key intervention population due to disproportionally high rates of sexually transmitted infections, limited or absent prenatal care, and significant unmet health needs. Tennessee’s female incarceration rate is 57% higher than the national average, and nearly one-third of women tested at intake are positive for syphilis. Current intake practices rely heavily on self-report, assumed adequate health literacy, and lack standardized STI screening requirements, contributing to missed diagnoses and preventable infant morbidity. The growing disconnection between the Tennessee Department of Health (TDH) and the Tennessee Department of Corrections (TDOC) further complicate efforts to establish equitable, evidence-based care across all correctional settings.

Policy Analysis Proposal

This policy analysis explored two evidence-based approached to reduce congenital syphilis through early identification in correctional facilities: (1) universal out-out syphilis screening for all incarcerated women of childbearing age in Tennessee, and (2) universal point-of-care (POC) rapid syphilis testing at intake in Tennessee correctional facilities. Both options aim to close gaps in current workflows, reduce reliance on self-reported risk factors, and leverage correctional intake as a consistent point of healthcare contact. These solutions build on national guidelines from the Centers of Disease Control and Prevention (CDC) and the National Commission for Correctional Healthcare (NCCHC), statewide congenital syphilis data, and lessons learned from successful pilot programs across Nevada, Alabama, and Florida.

Methods

Guided by the CDC Policy Analytical Framework and a data-driven model from Southeastern Louisiana University, this project used a comprehensive review of academic literature, Tennessee epidemiological data, and TDH project partner input to analyze feasibility, cost, equity, impact, and implementation requirements for each policy option. In a series of three reports, problem identification, needs assessment, key partner perspectives, financial modeling, and implementation considerations are all outlined and explored thoroughly.

Outcomes

Findings show that both proposed policy options would significantly improve early case detection. Universal opt-out screening aligns with national standards, integrates easily into existing intake workflows, and reduces stigma and provider bias. Universal POC testing provides immediate results, addressing challenges related to high turnover and delays in laboratory testing. Congenital syphilis currently costs Tennessee more than $5 million annually in preventable infant harm. Financial analysis demonstrated that these costs can be substantially offset through the 340B Drug Pricing Program and Section 318 federal funding.

Policy Recommendation

Based on feasibility, sustainability, financial impact, and statewide scalability, universal opt-out syphilis screening at correctional intake is recommended as the primary policy solution. The use of POC testing is supported as a valuable enhancement for facilities with adequate resources or high turnover rates. Both approaches benefit from a strengthened interagency partnership between TDH and TDOC in order to standardize training, workflows, evidence-based practice, and data collection.

Conclusion

Congenital syphilis remains a preventable cause of infant morbidity and mortality, and Tennessee correctional facilities are uniquely positioned to serve as an early intervention point. Implementing a universal opt-out screening protocol represents a practical, cost-effective, and equitable strategy that leverages existing infrastructure and funding while reducing preventable harm. This analysis highlights the critical role of interagency collaboration in order to advance health equity for incarcerated women and their infants.

Date

Fall 12-8-2025

First Advisor

Dr. Laura Gray

Department

Nursing, School of

College

Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project

Degree

Doctorate of Nursing Practice (DNP)

Degree Level

Doctoral

Degree Grantor

Belmont University

Keywords

correctional healthcare; congenital syphilis; women's health; policy; public health; syphilis screening; policy analysis; maternal health; health equity

Additional Files
Congenital Syphilis White Paper (1).pdf (2133 kB)
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