Presentation (CTI)

Problem Statement: Syphilis cases soared rampantly during 2021-2022. More rampant syphilis cases soar has been observed among American Indian and Alaska (AI/AN) people, more specifically, Great Plains and Southwest Tribes where syphilis cases had skyrocketed by 1,865%, during 2020-2022. Most service areas of these Great Plains and Southwest Tribes are rural or/and underserved communities where healthcare provider shortage is structural challenge of resolving above syphilis emergency. Another challenge of fighting syphilis emergency, particularly, among women in reproductive age (WRA) individuals of the Great Plains and Southwest Tribes is social and cultural norms regarding sexual health in rural communities where their social networks are small and relationships overlap.
Description: A, state-controlled high education institution, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas (UNLV)’s graduate medical education (GME) clinical rotation partnership with Ely Shoshone (Southwest rural community) Tribal Health System is an example of workforce capacity enhancement priority in response to syphilis emergency among WRA individuals of the Great Plains and Southwest Tribes. This prioritized partnership between Kirk Kerkorian School of Medicine GME and Ely Shoshone Tribal Health System is estimated to be cost-effective as the incremental cost-effective ratio (ICER) is $43,169; incremental cost, $19,858; congenital syphilis-free incremental quality-adjusted life year (QALY) by this partnership, 0.46; a Markov simulation model was adopted from a healthcare system (D-SNP) perspective. A 25 year-old Ely Shoshone Tribe woman for 19 years in order to return syphilis epidemiology back to before syphilis emergency 2020 as following the estimating methods. Chesson HW et al. Sex Transm Dis 2021; 48:253-259. doi: 10.1097/OLQ.0000000000001353; Kim et al. Sex Transm Dis. 2025 Sep 1;52(9):e64. doi: 10.1097/OLQ.0000000000002139.
Lessons Learned: Culturally adaptive sexually transmitted infection (STI) curriculum for the WRA tribal individuals and their partners implemented by the GME multispecialty clinical rotation was prioritized and implemented in 2024. In terms of recruitment and retention of rural practitioners, rural exposure during GME training promotes non-rural students and trainees to choose rural career pathway after their graduation; rural training is more strongly associated with rural practice than having a rural background. This prioritized partnership between academia and rural/tribal health systems aligns with the Center for Medicare and Medicaid Services' Rural Health Transformation to recruit and retain healthcare providers in rural and tribal communities.
Stakeholder Perspective: Healthcare system perspective with government-affiliated organizations (state-controlled high education system, Tribal Health System, Critical Access Clinic and Hospitals), and patients/caregivers with government payors (Indian Health Service, Tribal Employer Contribution, Medicaid or dual special needs plan)