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Rönn MM, Menzies NA, Gift TL, Chesson HW, Trikalinos TA, Bellerose M, Malyuta Y, Berruti A, Gaydos CA, Hsu KK, Salomon JA. Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis. Clin Infect Dis 2021; 70:1816-1823. [PMID: 31504314 PMCID: PMC7048627 DOI: 10.1093/cid/ciz519] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background Point-of-care testing (POCT) assays for chlamydia are being developed. Their potential impact on the burden of chlamydial infection in the United States, in light of suboptimal screening coverage, remains unclear. Methods Using a transmission model calibrated to data in the United States, we estimated the impact of POCT on chlamydia prevalence, incidence, and chlamydia-attributable pelvic inflammatory disease (PID) incidence, assuming status quo (Analysis 1) and improved (Analysis 2) screening frequencies. We tested the robustness of results to changes in POCT sensitivity, the proportion of patients getting treated immediately, the baseline proportion lost to follow-up (LTFU), and the average treatment delay. Results In Analysis 1, high POCT sensitivity was needed to reduce the chlamydia-associated burden. With a POCT sensitivity of 90%, reductions from the baseline burden only occurred in scenarios in which over 60% of the screened individuals would get immediate treatment and the baseline LTFU proportion was 20%. With a POCT sensitivity of 99% (baseline LTFU 10%, 2-week treatment delay), if everyone were treated immediately, the prevalence reduction was estimated at 5.7% (95% credible interval [CrI] 3.9–8.2%). If only 30% of tested persons would wait for results, the prevalence reduction was only 1.6% (95% CrI 1.1–2.3). POCT with 99% sensitivity could avert up to 12 700 (95% CrI 5000–22 200) PID cases per year, if 100% were treated immediately (baseline LTFU 20% and 3-week treatment delay). In Analysis 2, when POCT was coupled with increasing screening coverage, reductions in the chlamydia burden could be realized with a POCT sensitivity of 90%. Conclusions POCT could improve chlamydia prevention efforts if test performance characteristics are significantly improved over currently available options.
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Affiliation(s)
- Minttu M Rönn
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Nicolas A Menzies
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Thomas L Gift
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Harrell W Chesson
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom A Trikalinos
- Department of Health Services Policy & Practice, Brown University, Providence, Rhode Island
| | - Meghan Bellerose
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Yelena Malyuta
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Andrés Berruti
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Department of Medicine, John Hopkins University, Baltimore, Maryland
| | - Katherine K Hsu
- Division of Sexually Transmitted Disease Prevention & Human Immunodeficiency Virus/AIDS Surveillance, Massachusetts Department of Public Health, Boston
| | - Joshua A Salomon
- Prevention Policy Modeling Lab, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, California
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Rönn MM, Dunville R, Wang LY, Bellerose M, Malyuta Y, Menzies NA, Aslam M, Lewis F, Walker-Baban C, Asbel L, Parchem S, Masinter L, Perez E, Gift TL, Hsu K, Barrios LC, Salomon JA. Mathematical modeling study of school-based chlamydia screening: potential impact on chlamydia prevalence in intervention schools and surrounding communities. BMC Public Health 2020; 20:1363. [PMID: 32891137 PMCID: PMC7487537 DOI: 10.1186/s12889-020-09466-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/27/2020] [Indexed: 12/04/2022] Open
Abstract
Background Chlamydia screening in high schools offers a way to reach adolescents outside of a traditional clinic setting. Using transmission dynamic modeling, we examined the potential impact of high-school-based chlamydia screening programs on the burden of infection within intervention schools and surrounding communities, under varying epidemiological and programmatic conditions. Methods A chlamydia transmission model was calibrated to epidemiological data from three different settings. Philadelphia and Chicago are two high-burden cities with existing school-based screening programs. Rural Iowa does not have an existing program but represents a low-burden setting. We modeled the effects of the two existing programs to analyze the potential influence of program coverage and student participation. All three settings were used to examine a broader set of hypothetical programs with varying coverage levels and time trends in participation. Results In the modeled Philadelphia program, prevalence among the intervention schools’ sexually active 15–18 years old population was 4.34% (95% credible interval 3.75–4.71%)after 12 program years compared to 5.03% (4.39–5.43%) in absence of the program. In the modeled Chicago program, prevalence was estimated as 5.97% (2.60–7.88%) after 4 program years compared to 7.00% (3.08–9.29%) without the program. In the broader hypothetical scenarios including both high-burden and low-burden settings, impact of school-based screening programs was greater in absolute terms in the higher-prevalence settings, and benefits in the community were approximately proportional to population coverage of intervention schools. Most benefits were garnered if the student participation did not decline over time. Conclusions Sustained high student participation in school-based screening programs and broad coverage of schools within a target community are likely needed to maximize program benefits in terms of reduced burden of chlamydia in the adolescent population.
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Affiliation(s)
- Minttu M Rönn
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.
| | - Richard Dunville
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meghan Bellerose
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Yelena Malyuta
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Maria Aslam
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and PreventionPrevention, Atlanta, USA
| | - Felicia Lewis
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA.,STD Control Program, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Cherie Walker-Baban
- STD Control Program, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Lenore Asbel
- STD Control Program, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Sarah Parchem
- Bureau of Maternal, Infant, Child, and Adolescent Health, Chicago Department of Public Health, Chicago, USA
| | - Lisa Masinter
- Bureau of Maternal, Infant, Child, and Adolescent Health, Chicago Department of Public Health, Chicago, USA
| | - Ernestina Perez
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, USA
| | - Tom L Gift
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Katherine Hsu
- Division of STD Prevention & HIV/AIDS Surveillance, Massachusetts Department of Public Health, Jamaica Plain, USA
| | - Lisa C Barrios
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Salomon
- Center for Health Policy / Center for Primary Care and Outcomes Research, Stanford University, Stanford, USA
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Dembo R, Faber J, Cristiano J, Wareham J, Krupa J, Schmeidler J, Terminello A, DiClemente RJ. Individual- and Community-Level Factors in the STD Status of Justice-Involved Youth: Multi-Group, Exploratory Two-Level Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:2171-2186. [PMID: 31214909 DOI: 10.1007/s10508-018-1387-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 06/09/2023]
Abstract
Justice-involved youth display higher prevalence rates of sexually transmitted diseases (STDs), in comparison with youth in the general population, highlighting a critical public health concern. Individual factors are important predictors of STDs, but only provide a partial understanding of this public health issue. Communities experiencing higher levels of disorder and lower levels of cohesion tend to have fewer institutional resources available, which may impact sexual risk behavior and STDs. However, few studies have examined the association between community characteristics and STD prevalence among adolescents. The current study examined community-level (n = 106) characteristics and individual-level attributes in explaining STDs among justice-involved youth (n = 1233: n = 515 female; n = 718 male). At the individual level, results showed older males and those with more drug-related problems were more likely to be STD positive, while females with more sexual partners and those with less drug-related problems were more likely to be STD positive. At the community level, females residing in areas with fewer educated residents were more likely to be STD positive. These gender differences were significant, suggesting a gendered perspective is important for understanding STD infection. The justice system represents a critical opportunity in the treatment and prevention of STDs for youth.
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Affiliation(s)
- Richard Dembo
- Criminology Department, University of South Florida, Tampa, FL, 33620, USA.
| | - Jessica Faber
- Agency for Community Treatment Services, Inc., Tampa, FL, USA
| | | | - Jennifer Wareham
- Department of Criminal Justice, Wayne State University, Detroit, MI, USA
| | - Julie Krupa
- School of Criminal Justice, Michigan State University, East Lansing, MI, USA
| | - James Schmeidler
- Department of Psychiatry, Mt. Sinai School of Medicine, New York, NY, USA
| | - Asha Terminello
- Agency for Community Treatment Services, Inc., Tampa, FL, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Science, New York University, New York, NY, USA
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Lewis FMT, Dittus P, Salmon ME, Nsuami MJ. School-Based Sexually Transmitted Disease Screening: Review and Programmatic Guidance. Sex Transm Dis 2016; 43:S18-27. [PMID: 26779684 PMCID: PMC6747663 DOI: 10.1097/olq.0000000000000283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
School-based sexually transmitted disease (STD) screening (SBSS) was designed to provide chlamydia and gonorrhea testing, treatment, and counseling to adolescents in a school setting to overcome some of the difficulties of screening in this population. To inform STD control programs and other entities on decision making about potentially implementing this intervention, we reviewed existing published and gray literature on SBSS from 1998 to 2014. Although they are work-intensive to establish, school-based STD screening programs are a feasible and cost-effective way of testing large numbers of male and female adolescents for chlamydia and gonorrhea, and to provide counseling and treatment to almost all those who are found infected. School-based STD screening programs do not seem to reduce prevalence in either the school or the general adolescent population, although there are currently relatively few studies on large-scale SBSS. More research in this field is needed.
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Affiliation(s)
- Felicia M T Lewis
- From the *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †Philadelphia Department of Public Health, Philadelphia, PA; and ‡Louisiana State University Health Sciences Center, New Orleans, LA
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