Korenromp E L, Van Vliet C, Grosskurth H, Gavyole A, Van der Ploeg C P, Fransen L, Hayes R J, Habbema J D
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
AIDS. 2000 Mar 31;14(5):573-93. doi: 10.1097/00002030-200003310-00013.
To compare the impact of single-round mass treatment of sexually transmitted diseases (STD), sustained syndromic treatment and their combination on the incidence of HIV in rural Africa.
We studied the effects of STD interventions by stochastic simulation using the model STDSIM. Parameters were fitted using data from a trial of improved STD treatment services in Mwanza, Tanzania. Effectiveness was assessed by comparing the prevalences of gonorrhoea, chlamydia, syphilis and chancroid, and the incidence of HIV, in the general adult population in simulations with and without intervention.
Single-round mass treatment was projected to achieve an immediate, substantial reduction in STD prevalences, which would return to baseline levels over 5-10 years. The effect on syphilis was somewhat larger if participants cured of latent syphilis were not immediately susceptible to re-infection. At 80% coverage, the model projected a reduction in cumulative HIV incidence over 2 years of 36%. A similar impact was achieved if treatment of syphilis was excluded from the intervention or confined to those in the infectious stages. In comparison with sustained syndromic treatment, single-round mass treatment had a greater short-term impact on HIV (36 versus 30% over 2 years), but a smaller long-term impact (24 versus 62% over 10 years). Mass treatment combined with improved treatment services led to a rapid and sustained fall in HIV incidence (57% over 2 years; 70% over 10 years).
In populations in which STD control can reduce HIV incidence, mass treatment may, in the short run, have an impact comparable to sustained syndromic treatment. Mass treatment combined with sustained syndromic treatment may be particularly effective.
比较一次性大规模性传播疾病（STD）治疗、持续性症状性治疗及其联合治疗对非洲农村地区艾滋病毒发病率的影响。
我们使用模型STDSIM通过随机模拟研究了STD干预措施的效果。参数采用来自坦桑尼亚姆万扎一项改善STD治疗服务试验的数据进行拟合。通过比较有干预和无干预模拟中普通成年人群中淋病、衣原体感染、梅毒和软下疳的患病率以及艾滋病毒的发病率来评估有效性。
预计一次性大规模治疗可使STD患病率立即大幅下降，并在5至10年内恢复到基线水平。如果潜伏梅毒治愈的参与者不会立即再次感染，对梅毒的影响会稍大一些。覆盖率达到80%时，该模型预测2年内累积艾滋病毒发病率将降低36%。如果干预措施中不包括梅毒治疗或仅对处于感染阶段的人进行治疗，也会产生类似的影响。与持续性症状性治疗相比，一次性大规模治疗对艾滋病毒的短期影响更大（2年内为36%对30%），但长期影响较小（10年内为24%对62%）。大规模治疗与改善治疗服务相结合导致艾滋病毒发病率迅速且持续下降（2年内为57%；10年内为70%）。
在STD控制可降低艾滋病毒发病率的人群中，短期内大规模治疗可能产生与持续性症状性治疗相当的影响。大规模治疗与持续性症状性治疗相结合可能特别有效。
