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Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis

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 State...

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Autores principales: Rönn, Minttu M, Menzies, Nicolas A, Gift, Thomas L, Chesson, Harrell W, Trikalinos, Tom A, Bellerose, Meghan, Malyuta, Yelena, Berruti, Andrés, Gaydos, Charlotte A, Hsu, Katherine K, Salomon, Joshua A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048627/
https://www.ncbi.nlm.nih.gov/pubmed/31504314
http://dx.doi.org/10.1093/cid/ciz519
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author Rönn, Minttu M
Menzies, Nicolas A
Gift, Thomas L
Chesson, Harrell W
Trikalinos, Tom A
Bellerose, Meghan
Malyuta, Yelena
Berruti, Andrés
Gaydos, Charlotte A
Hsu, Katherine K
Salomon, Joshua A
author_facet Rönn, Minttu M
Menzies, Nicolas A
Gift, Thomas L
Chesson, Harrell W
Trikalinos, Tom A
Bellerose, Meghan
Malyuta, Yelena
Berruti, Andrés
Gaydos, Charlotte A
Hsu, Katherine K
Salomon, Joshua A
author_sort Rönn, Minttu M
collection PubMed
description 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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spelling pubmed-70486272020-04-20 Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis Rönn, Minttu M Menzies, Nicolas A Gift, Thomas L Chesson, Harrell W Trikalinos, Tom A Bellerose, Meghan Malyuta, Yelena Berruti, Andrés Gaydos, Charlotte A Hsu, Katherine K Salomon, Joshua A Clin Infect Dis Articles and Commentaries 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. Oxford University Press 2020-05-01 2019-08-29 /pmc/articles/PMC7048627/ /pubmed/31504314 http://dx.doi.org/10.1093/cid/ciz519 Text en © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Articles and Commentaries
Rönn, Minttu M
Menzies, Nicolas A
Gift, Thomas L
Chesson, Harrell W
Trikalinos, Tom A
Bellerose, Meghan
Malyuta, Yelena
Berruti, Andrés
Gaydos, Charlotte A
Hsu, Katherine K
Salomon, Joshua A
Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis
title Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis
title_full Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis
title_fullStr Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis
title_full_unstemmed Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis
title_short Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis
title_sort potential for point-of-care tests to reduce chlamydia-associated burden in the united states: a mathematical modeling analysis
topic Articles and Commentaries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048627/
https://www.ncbi.nlm.nih.gov/pubmed/31504314
http://dx.doi.org/10.1093/cid/ciz519
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