Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
PLoS One. 2012;7(6):e39575. doi: 10.1371/journal.pone.0039575. Epub 2012 Jun 27.
The "classical model" for sexually transmitted infections treats partnerships as instantaneous events summarized by partner change rates, while individual-based and pair models explicitly account for time within partnerships and gaps between partnerships. We compared predictions from the classical and pair models over a range of partnership and gap combinations. While the former predicted similar or marginally higher prevalence at the shortest partnership lengths, the latter predicted self-sustaining transmission for gonorrhoea (GC) and Chlamydia (CT) over much broader partnership and gap combinations. Predictions on the critical level of condom use (C(c)) required to prevent transmission also differed substantially when using the same parameters. When calibrated to give the same disease prevalence as the pair model by adjusting the infectious duration for GC and CT, and by adjusting transmission probabilities for HIV, the classical model then predicted much higher C(c) values for GC and CT, while C(c) predictions for HIV were fairly close. In conclusion, the two approaches give different predictions over potentially important combinations of partnership and gap lengths. Assuming that it is more correct to explicitly model partnerships and gaps, then pair or individual-based models may be needed for GC and CT since model calibration does not resolve the differences.
性传播感染的“经典模型”将伴侣关系视为由伴侣更换率总结的瞬时事件,而基于个体和对的模型则明确考虑了伴侣关系内和伴侣关系之间的时间间隔。我们比较了在一系列伴侣关系和间隔组合下,经典模型和对模型的预测结果。虽然前者在最短的伴侣关系长度上预测出相似或略高的患病率,但后者预测淋病(GC)和衣原体(CT)在更广泛的伴侣关系和间隔组合下存在自我维持的传播。当使用相同的参数时,预防传播所需的 condom 使用临界水平(C(c))的预测结果也有很大差异。当通过调整 GC 和 CT 的传染性持续时间以及调整 HIV 的传播概率来使经典模型的疾病患病率与对模型相同进行校准后,经典模型随后预测出 GC 和 CT 的 C(c)值要高得多,而 HIV 的 C(c)预测值则相当接近。总之,这两种方法在伴侣关系和间隔长度的潜在重要组合上给出了不同的预测结果。假设更正确的方法是明确建模伴侣关系和间隔,那么对于 GC 和 CT 可能需要使用基于对或个体的模型,因为模型校准并不能解决这些差异。