Background: High and increasing syphilis rates among American Indian/Alaska Native communities and particularly among American Indian/Alaska Native women and infants call for immediate interventions to reach and offer syphilis testing to sexually active populations paired with timely treatment. Methods: The Great Plains Tribal Epidemiology Center within the Great Plains Tribal Leaders Health Board partnered with a local nontribal health care facility to offer free community-based syphilis testing in Rapid City, South Dakota, starting in December 2022 through June 2024. Participants received cash incentive cards for undergoing testing for syphilis, human immunodeficiency virus (HIV), and hepatitis C virus. Results: Fifteen community testing events were conducted. Laboratory-based syphilis testing was performed on 1434 unique individuals with an average age of 38.8 years. Seventy-six people were diagnosed with syphilis that had previously not been identified (prevalence, 5.3% [76 of 1434]; 51 [67.1%]) were female. Treatment was provided to 80.3% of people with syphilis (61 of 76) within an average of 36 days. In total, the 15 events cost $158,019 ($75,000 administrative staff time + $5100 laboratory staff time + $24,009 laboratory tests + $ 53,910 incentives) or $88 per test performed ($158,019 per 1797). The cost to identify a previously unidentified case was $2079 ($158,019 per 76 newly identified infected persons). Conclusions: This community-based screening event revealed high prevalence of undiagnosed syphilis. Incentives supported community members to access screening services. Collaborations between clinical, tribal, and public health entities to bring diagnosis and treatment services to patients using a community-based approach have clear benefits but need ongoing supportive resources to be maintained.

Syndromic surveillance has evolved into a vital public health tool, providing near real-time data to detect and respond to health threats. While states administer syndromic surveillance systems, Tribal Epidemiology Centers (TECs) serve American Indian and Alaska Native (AIAN) communities across multistate regions, often encountering significant barriers to data access and utilization. This manuscript explores how TECs access and use syndromic surveillance data to address health disparities in AIAN populations, highlighting successes, innovations, and ongoing challenges. The Alaska Native Epidemiology Center (ANEC), Great Plains Tribal Epidemiology Center (GPTEC), and Northwest Tribal Epidemiology Center (NWTEC) provide insights into their syndromic surveillance practices. This includes data access methods, the creation of dashboards and reports, technical assistance for Tribal Health Organizations (THOs), and strategies for overcoming jurisdictional and data-sharing barriers. TECs have successfully leveraged syndromic surveillance to monitor critical health issues, including respiratory illnesses, substance misuse, behavioral health, and maternal care. Collaborative efforts have addressed race misclassification and data gaps, enabling targeted interventions such as air purifier distribution and improving health care delivery for tribal veterans. However, TECs can face restrictive data use agreements, jurisdictional misalignments, and limited access to granular data, hindering their ability to serve AIAN communities comprehensively. Syndromic surveillance offers transformative potential for improving public health in AIAN communities. To fully realize this potential, systemic changes are needed to streamline data-sharing agreements and improve data accuracy. These efforts, along with strong collaborations between TECs and state health departments, are critical to advancing health equity, respecting tribal sovereignty, and ensuring timely, actionable insights for AIAN populations.