1
|
Tsoumanis A, Vanden Berghe W, Hens N, Van Dijck C. Estimating Partnership Duration among MSM in Belgium-A Modeling Study. Infect Dis Rep 2024; 16:435-447. [PMID: 38804442 PMCID: PMC11130929 DOI: 10.3390/idr16030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Mathematical modeling is widely used for describing infection transmission and evaluating interventions. The lack of reliable social parameters in the literature has been mentioned by many modeling studies, leading to limitations in the validity and interpretation of the results. Using data from the European MSM Internet survey 2017, we developed a network model to describe sex acts among MSM in Belgium. The model simulates daily sex acts among steady, persistent casual and one-off partners in a population of 10,000 MSM, grouped as low- or high-activity by using three different definitions. Model calibration was used to estimate partnership duration and homophily rates to match the distribution of cumulative sex partners over 12 months. We estimated an average duration between 1065 and 1409 days for steady partnerships, 4-6 and 251-299 days for assortative high- and low-activity individuals and 8-13 days for disassortative persistent casual partnerships, respectively, varying across the three definitions. High-quality data on social network and behavioral parameters are scarce in the literature. Our study addresses this lack of information by providing a method to estimate crucial parameters for network specification.
Collapse
Affiliation(s)
- Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium; (W.V.B.)
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, 2610 Antwerp, Belgium;
| | - Wim Vanden Berghe
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium; (W.V.B.)
| | - Niel Hens
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, 2610 Antwerp, Belgium;
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium; (W.V.B.)
| |
Collapse
|
2
|
Montes-Olivas S, Ozten Y, Homer M, Turner K, Fairley CK, Hocking JS, Tse D, Verschueren van Rees N, Wong WCW, Ong JJ. Evaluating the impact and cost-effectiveness of chlamydia management strategies in Hong Kong: A modeling study. Front Public Health 2022; 10:932096. [PMID: 35968473 PMCID: PMC9363901 DOI: 10.3389/fpubh.2022.932096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To illustrate the epidemiologic and cost-effectiveness impact of shifting the focus from population-based screening toward a targeted management approach for genital chlamydia infection. Design Modeling study, implementing an individual-based, stochastic, dynamic network model. Setting Hong Kong. Population A hypothetical sample network of 10,000 people with a partnership distribution based on Hong Kong's sexually active population of reproductive age (age 18–49 years). Interventions In this study, we present several scenarios with different implementations of universal vs. targeted screening (based on partner numbers). We also explored the impact of (1) screening only, (2) screening plus expedited partner therapy, and (3) screening plus partner testing. Primary outcome measures Change of chlamydia prevalence before and after implementing the different strategies. The cost-effectiveness analysis reports total direct cost from a health provider perspective, the QALYs gained, and incremental cost-effectiveness ratios (ICER). Results In comparing the effects of universal screening only and targeted screening of the high-risk population, the mean prevalence during the 10th year of intervention was 2.75 ± 0.30% and 2.35 ± 0.21%, respectively (compared with 3.24 ± 0.30% and 3.35 ± 0.21% before the interventions, respectively). The addition of contact tracing to the latter targeted screening scenario reduces the mean prevalence during the 10th year of intervention to 1.48 ± 0.13% (compared with 3.31 ± 0.33% at baseline) in the best-case of testing before treatment and maximal contact-tracing effectiveness (40%). Overall, the most effective scenarios were those for which interventions focused on the high-risk population defined by the number of partners, with contact tracing included. The ICER for targeted screening with contact tracing at 20% and 40% efficiency was $4,634 and $7,219 per QALY gained, respectively (10-year time horizon). Expedited partner therapy did not significantly impact overall chlamydia prevalence and caused overtreatment. Conclusions Our study suggests that targeted screening with strengthened contact tracing efforts is the most cost-effective strategy to reduce the prevalence of chlamydia in Hong Kong.
Collapse
Affiliation(s)
- Sandra Montes-Olivas
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Yaz Ozten
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Martin Homer
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Katy Turner
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne Sexual Health Center, Melbourne, VIC, Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Desiree Tse
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Nicolas Verschueren van Rees
- Physics Department, University of California, Berkeley, Berkeley, CA, United States
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - William C. W. Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jason J. Ong
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- *Correspondence: Jason J. Ong
| |
Collapse
|
3
|
Lorenc A, Brangan E, Kesten JM, Horner PJ, Clarke M, Crofts M, Steer J, Turner J, Muir P, Horwood J. What can be learnt from a qualitative evaluation of implementing a rapid sexual health testing, diagnosis and treatment service? BMJ Open 2021; 11:e050109. [PMID: 34686552 PMCID: PMC8543645 DOI: 10.1136/bmjopen-2021-050109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To investigate experiences of implementing a new rapid sexual health testing, diagnosis and treatment service. DESIGN A theory-based qualitative evaluation with a focused ethnographic approach using non-participant observations and interviews with patient and clinic staff. Normalisation process theory was used to structure interview questions and thematic analysis. SETTING A sexual health centre in Bristol, UK. PARTICIPANTS 26 patients and 21 staff involved in the rapid sexually transmitted infection (STI) service were interviewed. Purposive sampling was aimed for a range of views and experiences and sociodemographics and STI results for patients, job grades and roles for staff. 40 hours of observations were conducted. RESULTS Implementation of the new service required co-ordinated changes in practice across multiple staff teams. Patients also needed to make changes to how they accessed the service. Multiple small 'pilots' of process changes were necessary to find workable options. For example, the service was introduced in phases beginning with male patients. This responsive operating mode created challenges for delivering comprehensive training and communication in advance to all staff. However, staff worked together to adjust and improve the new service, and morale was buoyed through observing positive impacts on patient care. Patients valued faster results and avoiding unnecessary treatment. Patients reported that they were willing to drop-off self-samples and return for a follow-up appointment, enabling infection-specific treatment in accordance with test results, thus improving antimicrobial stewardship. CONCLUSIONS The new service was acceptable to staff and patients. Implementation of service changes to improve access and delivery of care in the context of stretched resources can pose challenges for staff at all levels. Early evaluation of pilots of process changes played an important role in the success of the service by rapidly feeding back issues for adjustment. Visibility to staff of positive impacts on patient care is important in maintaining morale.
Collapse
Affiliation(s)
- Ava Lorenc
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
| | - Emer Brangan
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Joanna M Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paddy J Horner
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Michael Clarke
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Megan Crofts
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jonathan Steer
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Jonathan Turner
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Peter Muir
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
4
|
Oeschger TM, Erickson DC. Visible colorimetric growth indicators of Neisseria gonorrhoeae for low-cost diagnostic applications. PLoS One 2021; 16:e0252961. [PMID: 34138928 PMCID: PMC8211239 DOI: 10.1371/journal.pone.0252961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/25/2021] [Indexed: 12/02/2022] Open
Abstract
N. gonorrhoeae is one of the most pressing antibiotic resistant threats of our time and low-cost diagnostics that can easily identify antibiotic resistance are desperately needed. However, N. gonorrhoeae responds so uniquely to growth conditions that it cannot be assumed gonorrhea will respond to common microbiological methods used for other pathogenic organisms. In this paper, we explore visual colorimetric indicators of N. gonorrhoeae growth that can be seen without a microscope or spectrophotometer. We evaluate growth media, pH indicators, resazurin-based dyes, and tetrazolium-based dyes for their use in simple colorimetric system. Overall, we identified Graver Wade media as the best at supporting robust gonococcal growth while also providing the least background when analyzing results of colorimetric tests. XTT, a tetrazolium-based dye, proved to show to brightest color change over time and not negatively impact the natural growth of N. gonorrhoeae. However, other dyes including PrestoBlue, MTT, and NBT are less expensive than XTT and work well when added after bacterial growth has already occurred. By identifying the specific use cases of these dyes, this research lays the groundwork for future development of a color-based antibiotic susceptibility low-cost test for N. gonorrhoeae.
Collapse
Affiliation(s)
- Taylor Mae Oeschger
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, United States of America
| | - David Carl Erickson
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, United States of America
- Division of Nutritional Science, Cornell University, Ithaca, New York, United States of America
- * E-mail:
| |
Collapse
|
5
|
Harding-Esch EM, Huntington SE, Harvey MJ, Weston G, Broad CE, Adams EJ, Sadiq ST. Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics. ACTA ACUST UNITED AC 2021; 25. [PMID: 33124553 PMCID: PMC7596918 DOI: 10.2807/1560-7917.es.2020.25.43.1900402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Widespread ceftriaxone antimicrobial resistance (AMR) threatens Neisseria gonorrhoeae (NG) treatment, with few alternatives available. AMR point-of-care tests (AMR POCT) may enable alternative treatments, including abandoned regimens, sparing ceftriaxone use. We assessed cost-effectiveness of five hypothetical AMR POCT strategies: A-C included a second antibiotic alongside ceftriaxone; and D and E consisted of a single antibiotic alternative, compared with standard care (SC: ceftriaxone and azithromycin). Aim Assess costs and effectiveness of AMR POCT strategies that optimise NG treatment and reduce ceftriaxone use. Methods The five AMR POCT treatment strategies were compared using a decision tree model simulating 38,870 NG-diagnosed England sexual health clinic (SHC) attendees; A micro-costing approach, representing cost to the SHC (for 2015/16), was employed. Primary outcomes were: total costs; percentage of patients given optimal treatment (regimens curing NG, without AMR); percentage of patients given non-ceftriaxone optimal treatment; cost-effectiveness (cost per optimal treatment gained). Results All strategies cost more than SC. Strategy B (azithromycin and ciprofloxacin (azithromycin preferred); dual therapy) avoided most suboptimal treatments (n = 48) but cost most to implement (GBP 4,093,844 (EUR 5,474,656)). Strategy D (azithromycin AMR POCT; monotherapy) was most cost-effective for both cost per optimal treatments gained (GBP 414.67 (EUR 554.53)) and per ceftriaxone-sparing treatment (GBP 11.29 (EUR 15.09)) but with treatment failures (n = 34) and suboptimal treatments (n = 706). Conclusions AMR POCT may enable improved antibiotic stewardship, but require net health system investment. A small reduction in test cost would enable monotherapy AMR POCT strategies to be cost-saving.
Collapse
Affiliation(s)
- Emma M Harding-Esch
- National Infection Service, Public Health England, London, United Kingdom.,Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | | | | | | | - Claire E Broad
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | | | - S Tariq Sadiq
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom.,National Infection Service, Public Health England, London, United Kingdom.,Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| |
Collapse
|
6
|
Ong JJ, Wi T, Hughes G, Williamson DA, Mayaud P, Chow EPF. Gonorrhoea: tackling the global epidemic in the era of rising antimicrobial resistance. Sex Health 2020; 16:397-400. [PMID: 32172790 DOI: 10.1071/sh19121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 11/23/2022]
Abstract
This Special Issue of Sexual Health aims to collate the latest evidence base focussed on understanding the current epidemic and transmission of gonorrhoea, choice of treatment, molecular epidemiology application, concerns about antimicrobial resistance and alternative prevention and control for gonorrhoea.
Collapse
Affiliation(s)
- Jason J Ong
- Central Clinical School, Monash University, Melbourne, Vic. 3053, Australia; and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; and Corresponding author.
| | - Teodora Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva 1211, Switzerland
| | - Gwenda Hughes
- National Infection Service, Public Health England, Colindale NW9 5EQ, UK
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Vic. 3000, Australia
| | - Philippe Mayaud
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Vic. 3053, Australia; and Melbourne Sexual Health Centre, Alfred Health, Carlton, Vic. 3053, Australia
| |
Collapse
|