2008-2010 年荷兰基于系统、选择、互联网的衣原体筛查实施情况的评估设计：初步结果对分析的启示

Evaluation design of a systematic, selective, internet-based, Chlamydia screening implementation in the Netherlands, 2008-2010: implications of first results for the analysis.

机构信息

Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands.

出版信息

BMC Infect Dis. 2010 Apr 7;10:89. doi: 10.1186/1471-2334-10-89.

DOI:10.1186/1471-2334-10-89

PMID:20374635

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2858140/

Abstract

BACKGROUND

A selective, systematic, Internet-based, Chlamydia Screening Implementation for 16 to 29-year-old residents started in three regions in the Netherlands in April 2008: in the cities of Amsterdam and Rotterdam and a more rural region, South Limburg. This paper describes the evaluation design and discusses the implications of the findings from the first screening round for the analysis. The evaluation aims to determine the effects of screening on the population prevalence of Chlamydia trachomatis after multiple screening rounds.

METHODS

A phased implementation or 'stepped wedge design' was applied by grouping neighbourhoods (hereafter: clusters) into three random, risk-stratified blocks (A, B and C) to allow for impact analyses over time and comparison of prevalences before and after one or two screening rounds. Repeated simulation of pre- and postscreening Chlamydia prevalences was used to predict the minimum detectable decline in prevalence. Real participation and positivity rates per region, block, and risk stratum (high, medium, and low community risk) from the 1st year of screening were used to substantiate predictions.

RESULTS

The results of the 1st year show an overall participation rate of 16% of 261,025 invitees and a positivity rate of 4.2%, with significant differences between regions and blocks. Prediction by simulation methods adjusted with the first-round results indicate that the effect of screening (minimal detectable difference in prevalence) may reach significance levels only if at least a 15% decrease in the Chlamydia positivity rate in the cities and a 25% decrease in the rural region after screening can be reached, and pre- and postscreening differences between blocks need to be larger.

CONCLUSIONS

With the current participation rates, the minimal detectable decline of Chlamydia prevalence may reach our defined significance levels at the regional level after the second screening round, but will probably not be significant between blocks of the stepped wedge design. Evaluation will also include other aspects and prediction models to obtain rational advice about future Chlamydia screening in the Netherlands.

摘要

背景

2008 年 4 月，在荷兰的三个地区启动了一项针对 16 至 29 岁居民的选择性、系统性、基于互联网的衣原体筛查计划：阿姆斯特丹和鹿特丹市以及一个较为农村的地区——南林堡。本文介绍了评估设计，并讨论了第一轮筛查结果对分析的影响。该评估旨在确定多次筛查轮次后，筛查对沙眼衣原体人群流行率的影响。

方法

采用分阶段实施或“阶梯式楔形设计”，通过将社区（以下简称：集群）分为三个随机、风险分层的组（A、B 和 C）来应用，以便进行随时间的影响分析，并比较一轮或两轮筛查前后的流行率。反复模拟筛查前后的衣原体流行率，以预测流行率最小可检测下降幅度。使用第一年筛查的每个地区、每个块和每个风险层（高、中、低社区风险）的实际参与率和阳性率来证实预测结果。

结果

第一年的结果显示，261025 名受邀者的总体参与率为 16%，阳性率为 4.2%，不同地区和块之间存在显著差异。通过模拟方法预测，结合第一轮结果调整后，如果在城市地区能将衣原体阳性率降低至少 15%，在农村地区降低 25%，且楔形设计中块之间的预筛和筛后差异较大，那么筛查的效果（流行率最小可检测差异）可能达到显著水平。