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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 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.
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Affiliation(s)
- Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
- 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
| | - 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
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Dias BDC, Sekgele W, Nhlapo D, Mahlangu MP, Venter JME, Maseko DV, Müller EE, Greeves M, Botha P, Radebe F, Kufa T, Kularatne RS. Extragenital Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men in Johannesburg, South Africa. Sex Transm Dis 2024; 51:245-250. [PMID: 38534082 DOI: 10.1097/olq.0000000000001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND In South Africa, extragenital etiological sexually transmitted infection (STI) screening among men who have sex with men (MSM) is not routinely available. We aimed to determine the prevalence of STI pathogens at rectal and pharyngeal sites, syphilis seroprevalence, and associated risk factors among a selection of high-risk MSM without symptomatic urethritis attending a men's health clinic in Johannesburg, South Africa. METHODS A cross-sectional study was conducted in 2022. Enrolled clients self-reported demographic, sexual behavioral risks, and clinical information. Client or clinician-collected rectal and pharyngeal swabs were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. C. trachomatis-positive rectal samples were reflex tested for lymphogranuloma venereum. Blood specimens were screened for syphilis. Univariate and multivariate regression models were used to determine factors independently associated with the presence of an extragenital STI or syphilis. RESULTS Among the 97 participants (median age, 29 years), 24.7% had an extragenital STI and 9.4% had high nontreponemal antibody titers (rapid plasma reagin ≥1:16). Rectal STIs were detected in 26.4% participants: N. gonorrhoeae (14.3%), C. trachomatis (9.9%), and M. genitalium (5.5%). Pharyngeal STIs were less prevalent (4.1%). Overall, the prevalence of any STI was 41%. Sex under the influence of drugs (adjusted odds ratio, 4.94; 95% confidence interval, 1.56-15.69) and engaging in condomless receptive anal intercourse with a casual partner (adjusted odds ratio, 8.36; 95% confidence interval, 1.73-40.28) were independent risk factors for having an extragenital STI. CONCLUSIONS The high burden of extragenital STIs and active syphilis in asymptomatic MSM underscores the importance of routine etiological screening in this key population, as the syndromic approach would not enable detection or treatment of these infections.
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Affiliation(s)
| | - Windy Sekgele
- South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases
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Williams E, Williamson DA, Hocking JS. Frequent screening for asymptomatic chlamydia and gonorrhoea infections in men who have sex with men: time to re-evaluate? THE LANCET. INFECTIOUS DISEASES 2023; 23:e558-e566. [PMID: 37516129 DOI: 10.1016/s1473-3099(23)00356-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/02/2023] [Accepted: 05/15/2023] [Indexed: 07/31/2023]
Abstract
There is increasing debate regarding the harms and benefits of frequent asymptomatic screening for Chlamydia trachomatis and Neisseria gonorrhoeae in men who have sex with men (MSM). One concern is that frequent asymptomatic screening could result in increased antimicrobial resistance in an array of sexually acquired infections and other pathogens, due to selection pressure exerted by frequent broad-spectrum antimicrobial usage within some sexual networks. Here, we outline the harms and benefits of frequent C trachomatis and N gonorrhoeae screening in MSM in high-income settings and propose that screening frequency be reduced. We describe the evidence gaps that should be further explored to better understand the implications of reducing the frequency of asymptomatic C trachomatis and N gonorrhoeae screening in MSM and the surveillance systems that should be in place to prepare for such changes.
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Affiliation(s)
- Eloise Williams
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
| | - Deborah A Williamson
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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4
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Jenness SM, Le Guillou A, Lyles C, Bernstein KT, Krupinsky K, Enns EA, Sullivan PS, Delaney KP. The Role of HIV Partner Services in the Modern Biomedical HIV Prevention Era: A Network Modeling Study. Sex Transm Dis 2022; 49:801-807. [PMID: 36194831 PMCID: PMC9668377 DOI: 10.1097/olq.0000000000001711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND HIV partner services can accelerate the use of antiretroviral-based HIV prevention tools (antiretroviral therapy [ART] and preexposure prophylaxis [PrEP]), but its population impact on long-term HIV incidence reduction is challenging to quantify with traditional partner services metrics of partner identified or HIV screened. Understanding the role of partner services within the portfolio of HIV prevention interventions, including using it to efficiently deliver antiretrovirals, is needed to achieve HIV prevention targets. METHODS We used a stochastic network model of HIV/sexually transmitted infection transmission for men who have sex with men, calibrated to surveillance-based estimates in the Atlanta area, a jurisdiction with high HIV burden and suboptimal partner services uptake. Model scenarios varied successful delivery of partner services cascade steps (newly diagnosed "index" patient and partner identification, partner HIV screening, and linkage or reengagement of partners in PrEP or ART care) individually and jointly. RESULTS At current levels observed in Atlanta, removal of HIV partner services had minimal impact on 10-year cumulative HIV incidence, as did improving a single partner services step while holding the others constant. These changes did not sufficiently impact overall PrEP or ART coverage to reduce HIV transmission. If all index patients and partners were identified, maximizing partner HIV screening, partner PrEP provision, partner ART linkage, and partner ART reengagement would avert 6%, 11%, 5%, and 18% of infections, respectively. Realistic improvements in partner identification and service delivery were estimated to avert 2% to 8% of infections, depending on the combination of improvements. CONCLUSIONS Achieving optimal HIV prevention with partner services depends on pairing improvements in index patient and partner identification with maximal delivery of HIV screening, ART, and PrEP to partners if indicated. Improving the identification steps without improvement to antiretroviral service delivery steps, or vice versa, is projected to result in negligible population HIV prevention benefit.
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Affiliation(s)
| | | | | | - Kyle T. Bernstein
- STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Eva A. Enns
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
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5
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Augsburger IB, Galanthay GK, Tarosky JH, Rychtář J, Taylor D. Voluntary vaccination may not stop monkeypox outbreak: A game-theoretic model. PLoS Negl Trop Dis 2022; 16:e0010970. [PMID: 36516113 DOI: 10.1371/journal.pntd.0010970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Monkeypox (MPX) is a viral zoonotic disease that was endemic to Central and West Africa. However, during the first half of 2022, MPX spread to almost 60 countries all over the world. Smallpox vaccines are about 85% effective in preventing MPX infections. Our objective is to determine whether the vaccines should be mandated or whether voluntary use of the vaccine could be enough to stop the MPX outbreak. We incorporate a standard SVEIR compartmental model of MPX transmission into a game-theoretical framework. We study a vaccination game in which individuals decide whether or not to vaccinate by assessing their benefits and costs. We solve the game for Nash equilibria, i.e., the vaccination rates the individuals would likely adopt without any outside intervention. We show that, without vaccination, MPX can become endemic in previously non-endemic regions, including the United States. We also show that to "not vaccinate" is often an optimal solution from the individual's perspective. Moreover, we demonstrate that, for some parameter values, there are multiple equilibria of the vaccination game, and they exhibit a backward bifurcation. Thus, without centrally mandated minimal vaccination rates, the population could easily revert to no vaccination scenario.
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Affiliation(s)
- Ian B Augsburger
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Grace K Galanthay
- Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, Massachusetts, United States of America
| | - Jacob H Tarosky
- Department of Mathematical Sciences, High Point University, High Point, North Carolina, United States of America
| | - Jan Rychtář
- Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Dewey Taylor
- Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, Virginia, United States of America
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Jones J, Le Guillou A, Gift TL, Chesson H, Bernstein K, Delaney K, Lyles C, Berruti A, Sullivan PS, Jenness SM. Effect of Screening and Treatment for Gonorrhea and Chlamydia on HIV Incidence Among Men Who Have Sex With Men in the United States: A Modeling Analysis. Sex Transm Dis 2022; 49:669-676. [PMID: 35921635 PMCID: PMC9481699 DOI: 10.1097/olq.0000000000001685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous models have estimated the total population attributable fraction of Neisseria gonorrhoeae and Chlamydia trachomatis (NG/CT) on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM. METHODS Using a network model, we estimated the effects of varying coverage levels for sexually transmitted infection screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing the proportion of screening events that include rectal screening for NG/CT on HIV incidence. RESULTS Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.9% of HIV infections over a 10-year period (interquartile range, 2.8%-6.8%). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (interquartile range, 8.1%-11.6%). Increased sexually transmitted infection screening among MSM without HIV averted more new HIV infections compared with the transmissions averted because of screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection. CONCLUSIONS Screening of NG/CT among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Thomas L. Gift
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Harrell Chesson
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kyle Bernstein
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kevin Delaney
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Cynthia Lyles
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Andres Berruti
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University
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Aung ET, Chow EP, Fairley CK, Phillips TR, Chen MY, Tran J, Maddaford K, Rodriguez ER, Ong JJ. Preferences of men who have sex with men for performing anal self-examination for the detection of anal syphilis in Australia: A discrete choice experiment. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 21:100401. [PMID: 35243457 PMCID: PMC8873922 DOI: 10.1016/j.lanwpc.2022.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Regular anal self-examination could potentially reduce syphilis transmission by detecting anal syphilis earlier among men who have sex with men (MSM). This study aimed to examine the preferences of MSM on performing anal self-examination to detect anal syphilis. METHODS An online survey with a discrete choice experiment (DCE) was distributed to MSM attending a sexual health clinic and through social media in Australia between June and November 2020. The DCE examined the preferred attributes of anal self-examination that would encourage MSM to perform anal self-examination. Data were analysed using a random parameters logit (RPL) model. FINDINGS The median age of 557 MSM who completed the survey was 35 (inter quartile range, 27-45). The choice to perform anal self-examination was most influenced by two attributes: the accuracy of anal self-examination to diagnose anal syphilis, and the frequency of anal self-examination, followed by the type of instruction materials to perform anal self-examination, waiting time for medical review, and type of support received if abnormalities were found. Using the most preferred attributes, 98% of people would conduct anal self-examination compared with 35% when the least preferred anal self-examination attributes were offered. INTERPRETATION If anal self-examination were recommended for anal syphilis screening, it will be important to consider preferences of MSM: men were more likely to undertake anal self-examination if the frequency was once a month and there was higher accuracy of detecting anal syphilis. FUNDING Australian National Health And Medical Research Council.
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Affiliation(s)
- Ei T. Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P.F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tiffany R. Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y. Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Julien Tran
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Elena R. Rodriguez
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Jenness SM, Le Guillou A, Chandra C, Mann LM, Sanchez T, Westreich D, Marcus JL. Projected HIV and Bacterial Sexually Transmitted Infection Incidence Following COVID-19-Related Sexual Distancing and Clinical Service Interruption. J Infect Dis 2021; 223:1019-1028. [PMID: 33507308 PMCID: PMC7928867 DOI: 10.1093/infdis/jiab051] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The global COVID-19 pandemic has the potential to indirectly impact transmission dynamics and prevention of HIV and other sexually transmitted infections (STI). It is unknown what combined impact reductions in sexual activity and interruptions in HIV/STI services will have on HIV/STI epidemic trajectories. METHODS We adapted a model of HIV, gonorrhea, and chlamydia for a population of approximately 103 000 men who have sex with men (MSM) in the Atlanta area. Model scenarios varied the timing, overlap, and relative extent of COVID-19-related sexual distancing and service interruption within 4 service categories (HIV screening, preexposure prophylaxis, antiretroviral therapy, and STI treatment). RESULTS A 50% relative decrease in sexual partnerships and interruption of all clinical services, both lasting 18 months, would generally offset each other for HIV (total 5-year population impact for Atlanta MSM, -227 cases), but have net protective effect for STIs (-23 800 cases). If distancing lasted only 3 months but service interruption lasted 18 months, the total 5-year population impact would be an additional 890 HIV cases and 57 500 STI cases. CONCLUSIONS Immediate action to limit the impact of service interruptions is needed to address the indirect effects of the global COVID-19 pandemic on the HIV/STI epidemic.
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Affiliation(s)
- Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | - Christina Chandra
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Laura M Mann
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
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Spornraft-Ragaller P. [Rapid testing for sexually transmitted infections]. MMW Fortschr Med 2020; 162:44-48. [PMID: 32583248 DOI: 10.1007/s15006-020-0646-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Petra Spornraft-Ragaller
- Immunschwäche-Ambulanz, Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, D-01307, Dresden, Deutschland.
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10
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Earnest R, Rönn MM, Bellerose M, Gift TL, Berruti AA, Hsu KK, Testa C, Zhu L, Malyuta Y, Menzies NA, Salomon JA. Population-level Benefits of Extragenital Gonorrhea Screening Among Men Who Have Sex With Men: An Exploratory Modeling Analysis. Sex Transm Dis 2020; 47:484-490. [PMID: 32355108 PMCID: PMC7903327 DOI: 10.1097/olq.0000000000001189] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately burdened by gonorrhea and face high rates of extragenital (rectal and pharyngeal) infection, which is mostly asymptomatic and often missed by urogenital-only screening. Extragenital screening likely remains below Centers for Disease Control and Prevention-recommended levels. Because increasing screening coverage is often resource-intensive, we assessed whether improved extragenital screening among men already presenting at clinics could lead to substantial reductions in prevalence and incidence. METHODS We calibrated an agent-based model of site- and race-specific gonorrhea infection in MSM to explicitly model multisite infection within an individual and transmission via anal, orogenital, and ororectal sex. Compared with current screening levels, we assessed the impact of increasing screening at (1) both extragenital sites, (2) only the rectal site, and (3) only the pharyngeal site among men already being urogenitally screened. RESULTS All scenarios reduced prevalence and incidence, with improved screening at both extragenital sites having the largest effect across outcomes. Extragenitally screening 100% of men being urogenitally screened reduced site-specific prevalence by an average of 42% (black MSM) and 50% (white MSM), with these values dropping by approximately 10% and 20% for each race group when targeting only the rectum and only the pharynx, respectively. However, increasing only rectal screening was more efficient in terms of the number of screens needed to avert an infection as this avoided duplicative screens due to rectum/pharynx multisite infection. CONCLUSIONS Improved extragenital screening substantially reduced site-specific gonorrhea prevalence and incidence, with strategies aimed at increasing rectal screening proving the most efficient.
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Affiliation(s)
- Rebecca Earnest
- Prevention Policy Modeling Laboratory, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Minttu M. Rönn
- Prevention Policy Modeling Laboratory, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Meghan Bellerose
- Prevention Policy Modeling Laboratory, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Thomas L. Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Andrés A. Berruti
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Katherine K. Hsu
- Division of STD Prevention and HIV/AIDS Surveillance, Massachusetts Department of Public Health, Boston, MA
| | - Christian Testa
- Prevention Policy Modeling Laboratory, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Lin Zhu
- Center for Health Policy/Center for Primary Care and Outcomes Research, School of Medicine, Stanford University, Stanford, CA
| | - Yelena Malyuta
- Prevention Policy Modeling Laboratory, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Nicolas A. Menzies
- Prevention Policy Modeling Laboratory, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Joshua A. Salomon
- Prevention Policy Modeling Laboratory, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
- Center for Health Policy/Center for Primary Care and Outcomes Research, School of Medicine, Stanford University, Stanford, CA
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11
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Sexually transmitted infections among African women: an opportunity for combination sexually transmitted infection/HIV prevention. AIDS 2020; 34:651-658. [PMID: 32167988 DOI: 10.1097/qad.0000000000002472] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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