TY - JOUR
T1 - The Potential Population-Level Impact of Different Gonorrhea Screening Strategies in Baltimore and San Francisco
T2 - An Exploratory Mathematical Modeling Analysis
AU - Rönn, Minttu M.
AU - Testa, Christian
AU - Tuite, Ashleigh R.
AU - Chesson, Harrell W.
AU - Gift, Thomas L.
AU - Schumacher, Christina
AU - Williford, Sarah L.
AU - Zhu, Lin
AU - Bellerose, Meghan
AU - Earnest, Rebecca
AU - Malyuta, Yelena
AU - Hsu, Katherine K.
AU - Salomon, Joshua A.
AU - Menzies, Nicolas A.
N1 - Publisher Copyright:
© Lippincott Williams & Wilkins.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Background Baltimore and San Francisco represent high burden areas for gonorrhea in the United States. We explored different gonorrhea screening strategies and their comparative impact in the 2 cities. Methods We used a compartmental transmission model of gonorrhea stratified by sex, sexual orientation, age, and race/ethnicity, calibrated to city-level surveillance data for 2010 to 2017. We analyzed the benefits of 5-year interventions which improved retention in care cascade or increased screening from current levels. We also examined a 1-year outreach screening intervention of high-activity populations. Results In Baltimore, annual screening of population aged 15 to 24 years was the most efficient of the 5-year interventions with 17.9 additional screening tests (95% credible interval [CrI], 11.8-31.4) needed per infection averted while twice annual screening of the same population averted the most infections (5.4%; 95% CrI, 3.1-8.2%) overall with 25.3 (95% CrI, 19.4-33.4) tests per infection averted. In San Francisco, quarter-annual screening of all men who have sex with men was the most efficient with 16.2 additional (95% CrI, 12.5-44.5) tests needed per infection averted, and it also averted the most infections (10.8%; 95% CrI, 1.2-17.8%). Interventions that reduce loss to follow-up after diagnosis improved outcomes. Depending on the ability of a short-term outreach screening to screen populations at higher acquisition risk, such interventions can offer efficient ways to expand screening coverage. Conclusions Data on gonorrhea prevalence distribution and time trends locally would improve the analyses. More focused intervention strategies could increase the impact and efficiency of screening interventions.
AB - Background Baltimore and San Francisco represent high burden areas for gonorrhea in the United States. We explored different gonorrhea screening strategies and their comparative impact in the 2 cities. Methods We used a compartmental transmission model of gonorrhea stratified by sex, sexual orientation, age, and race/ethnicity, calibrated to city-level surveillance data for 2010 to 2017. We analyzed the benefits of 5-year interventions which improved retention in care cascade or increased screening from current levels. We also examined a 1-year outreach screening intervention of high-activity populations. Results In Baltimore, annual screening of population aged 15 to 24 years was the most efficient of the 5-year interventions with 17.9 additional screening tests (95% credible interval [CrI], 11.8-31.4) needed per infection averted while twice annual screening of the same population averted the most infections (5.4%; 95% CrI, 3.1-8.2%) overall with 25.3 (95% CrI, 19.4-33.4) tests per infection averted. In San Francisco, quarter-annual screening of all men who have sex with men was the most efficient with 16.2 additional (95% CrI, 12.5-44.5) tests needed per infection averted, and it also averted the most infections (10.8%; 95% CrI, 1.2-17.8%). Interventions that reduce loss to follow-up after diagnosis improved outcomes. Depending on the ability of a short-term outreach screening to screen populations at higher acquisition risk, such interventions can offer efficient ways to expand screening coverage. Conclusions Data on gonorrhea prevalence distribution and time trends locally would improve the analyses. More focused intervention strategies could increase the impact and efficiency of screening interventions.
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U2 - 10.1097/OLQ.0000000000001108
DO - 10.1097/OLQ.0000000000001108
M3 - Article
C2 - 31842089
AN - SCOPUS:85079098051
SN - 0148-5717
VL - 47
SP - 143
EP - 150
JO - Sexually transmitted diseases
JF - Sexually transmitted diseases
IS - 3
ER -