Utilizing an Equitable and Multifaceted Zika Screening Tool to Identify At-Risk Individuals For Testing and Education: Successes, Challenges, and Lessons Learned in Harris County, Texas.

Abstract

Background. Harris County Public Health (HCPH) is the health department for Harris County, Texas jurisdiction, representing 2.3 million residents. Located in the nation's Third most populous county, HCPH's 13 wellness clinics and WIC centers provide services for over 100,000 patients annually. Since late 2015, HCPH confirmed 46 individuals with Zika infection/disease, including two infants with microcephaly and congenital disease. Over two-thirds of these infections were in individuals of Hispanic origin, including all twelve infected pregnant women, two of whom were unaccompanied minors. Due to Harris County's geographic vulnerability to Zika, highly mobile residents, and HCPH's largely low-income Hispanic and refugee clinic population, equitably screening and educating patients about Zika exposure is of paramount importance. Methods. Using U.S. CDC guidelines, HCPH developed a multifaceted Zika Screening Tool (ZST) for use within clinics. Front desk staff, outreach workers, nursing staff, and clinical providers all participate in various portions of the education-based screening process. The ZST is updated as new CDC guidance becomes available. Results. All pregnant and high-risk patients received Zika education. Fortyfive patients, mostly pregnant females, were additionally referred for testing and further care. Conclusion. HCPH's ZST successfully identified high-risk patients for education and testing. This presentation will explore HCPH's equity-based rationale for education- oriented screening, the ZST's evolution over time, and describe ZST forms and their integration into the clinic visit. Successful implementation strategies, challenges, and lessons learned will also be discussed, along with the role of the ZST as an integral part of HCPH's overall multidisciplinary Zika response effort.