HLTH 6362 Week 10 Think Syphilis Program Critique Example

Program Critique: What the Evaluation of Arizona's Think Syphilis Campaign in Maricopa County Measured, Who Ran It, How It Was Designed and Which of Its Results Are Negative Findings Versus Simply Absent Ones

Student Name

Walden University

HLTH 6362: Sexual Health and Well-Being

Instructor Name

Month Day, Year

Program Critique: What the Evaluation of Arizona's Think Syphilis Campaign in Maricopa County Measured, Who Ran It, How It Was Designed and Which of Its Results Are Negative Findings Versus Simply Absent Ones

The Program and Its Evaluation

Think Syphilis is a public health campaign in Arizona, a state that has had one of the highest congenital syphilis rates in the country and whose law requires syphilis testing of pregnant women at three points: the first visit, the third trimester and delivery (Centers for Disease Control and Prevention [CDC], 2025). Gabir et al. (2025) report an evaluation conducted in Maricopa County. This critique sets out what was evaluated, by whom, with what design and against which outcomes, and then judges what the results can and cannot be taken to show. It does not treat the campaign's existence, or providers' approval of it, as evidence that it worked.

What Was Evaluated

The evaluation had three stated purposes: to assess compliance with the state's mandated three-point testing among prenatal care providers, to describe access to benzathine penicillin G treatment and to assess receipt and use of Think Syphilis campaign materials (Gabir et al., 2025). Only the third purpose concerns the campaign directly. The first two describe the setting in which the campaign operated.

Who Ran It

The study was conducted by staff of the Maricopa County Department of Public Health, and the authors report that it received no specific funding. An evaluation run by the agency responsible for the campaign is common and often practical, but it means the evaluators were not independent of the program. That does not invalidate the findings; it is a fact a reader should weigh, particularly for any finding favorable to the program.

Design

The design was a facility-level cross-sectional survey of prenatal care providers and clinical staff, conducted in 2022 and 2023. Responses from individual participants were applied to their facilities, including satellite offices in the same corporations. The survey captured 42 distinct facilities representing 104 outpatient obstetric and gynecologic settings and 232 delivering providers, who together accounted for 33,196 live births, about 68% of the county's live births in 2021 (Gabir et al., 2025).

The coverage of births is a strength: the facilities represent most deliveries in the county. The design's limits are equally clear. A single survey at one point in time cannot show change. Responses are self-reported by providers and staff, not drawn from medical records. And applying one person's answer to a whole facility, including satellite offices, assumes that practice is uniform across sites.

Outcomes and Results

Nearly all facilities, 97.6%, reported having syphilis screening policies for pregnant women. Reported compliance with testing was 78.6% at the first prenatal visit and 73.8% in the third trimester. Among respondents with first-hand knowledge of hospital practices, 76.5% reported screening at delivery. Only 11.9% of facilities said they administer benzathine penicillin G themselves, while 71.4% referred patients with syphilis elsewhere, most often to the county's sexually transmitted infection clinic; barriers to on-site treatment included cost and a perception of syphilis as rare. On the campaign itself, 21.4% of facilities confirmed receiving Think Syphilis materials, and most of those shared them with staff (Gabir et al., 2025).

Negative Findings

Two results are genuine negative findings, meaning the evaluation looked for something and found little of it.

The first is on-site treatment. Fewer than one facility in eight reported treating syphilis on site. For a condition in which treatment has to start no later than 30 days before birth to prevent congenital infection (Workowski et al., 2021), referral to another site adds a step at which care can be lost. Nationally, inadequate treatment despite timely diagnosis has been the most common missed prevention opportunity (Kimball et al., 2020). This finding identifies a concrete gap.

The second is campaign reach. Only about one facility in five confirmed receiving campaign materials. Whatever the materials' quality, most of the facilities that deliver most of the county's babies did not report having them.

Absent Findings

Several questions a reader might expect answered were not measured at all, and their absence should not be read as either success or failure.

The evaluation did not measure congenital syphilis cases, maternal treatment outcomes or the timing of treatment relative to delivery. It therefore offers no evidence, positive or negative, on whether the campaign prevented any infant infections.

It did not compare facilities that received materials with those that did not, or measure testing before and after the campaign. So the testing compliance figures, which the authors describe as substantial, cannot be credited to the campaign.

It did not verify reported compliance against records. A self-reported 73.8% third-trimester testing rate is a provider estimate, not an audited one.

What a Stronger Evaluation Would Add

The point of listing additions is not to fault the authors, who described their study accurately, but to show what kind of study would answer the campaign question.

Three additions would turn this description into an evaluation of the campaign. First, a comparison: testing and treatment measures at facilities before and after the campaign, or at facilities that received materials against those that did not. Second, record-based outcomes: the share of pregnant patients with documented third-trimester tests and the time from a positive test to treatment, drawn from charts or surveillance data rather than provider estimates. Third, a link to congenital outcomes, even if only through trends in county surveillance with appropriate caution about other influences. None of these would be simple, but without them the campaign's effect remains unknown rather than negative.

What the Critique Concludes

The evaluation is useful as a description of the care environment: testing policies are nearly universal, reported testing is fairly high and on-site treatment is rare. It is weak as an evaluation of the campaign, because the only campaign outcome measured, receipt of materials, was low and no outcome linked the campaign to testing or treatment. A health educator adapting Think Syphilis elsewhere, for instance in South Dakota, where a single early test is all the statute demands (S.D. Codified Laws § 34-23-9), ought to take from it the treatment-access finding and a lesson about distribution, not evidence that the campaign changes outcomes.

References

Attending physician to take blood sample from pregnant woman, S.D. Codified Laws § 34-23-9 (2025).

Centers for Disease Control and Prevention. (2025). State statutory and regulatory language regarding prenatal syphilis screenings in the United States. Division of STD Prevention.

Gabir, L., Bell, J., Praag, A., Rios, M., Devlin, S., Khurana, R., & Taylor, M. M. (2025). Think Syphilis: Evaluating testing and treatment services for pregnant women attending prenatal care in Maricopa County, Arizona. Sexually Transmitted Diseases, 52(12), 739-745. https://doi.org/10.1097/OLQ.0000000000002223

Kimball, A., Torrone, E., Miele, K., Bachmann, L., Thorpe, P., Weinstock, H., & Bowen, V. (2020). Missed opportunities for prevention of congenital syphilis, United States, 2018. Morbidity and Mortality Weekly Report, 69(22), 661-665. https://doi.org/10.15585/mmwr.mm6922a1

Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021). Sexually transmitted infections treatment guidelines, 2021. MMWR Recommendations and Reports, 70(4), 1-187. https://doi.org/10.15585/mmwr.rr7004a1