对年轻男性进行筛查对女性发病率的影响：一项针对高流行社区的网络建模研究。
Effect of screening young men for on the rates among women: a network modelling study for high-prevalence communities.
作者信息
Qu Zhuolin, Azizi Asma, Schmidt Norine, Craig-Kuhn Megan Clare, Stoecker Charles, Hyman James Mac, Kissinger Patricia J
机构信息
Department of Mathematics, Tulane University, New Orleans, Louisiana, USA.
Department of Mathematics, The University of Texas at San Antonio, San Antonio, Texas, USA.
出版信息
BMJ Open. 2021 Jan 22;11(1):e040789. doi: 10.1136/bmjopen-2020-040789.
OBJECTIVE
(Ct) is the most commonly reported sexually transmitted infection in the USA and causes important reproductive morbidity in women. The Centers for Disease Control and Prevention recommend routine screening of sexually active women under age 25 but not among men. Despite three decades of screening women, chlamydia prevalence in women remains high. Untested and untreated men can serve as a reservoir of infection in women, and male-screening based intervention can be an effective strategy to reduce infection in women. We assessed the impact of screening men on the Ct prevalence in women.
DESIGN
We created an individual-based network model to simulate a realistic chlamydia epidemic on sexual contact networks for a synthetic population (n=5000). The model is calibrated to the ongoing routine screening among African American (AA) women in the USA and detailed a male-screening programme, Check It, that bundles best practices for Ct control. We used sensitivity analysis to quantify the relative importance of each intervention component.
SETTING
Community-based venues in New Orleans, Louisiana, USA.
PARTICIPANTS
Heterosexual AA men, aged 15 to 24, who had sex with women in the past 2 months.
INTERVENTION
Venue-based screening, expedited index treatment, expedited partner treatment and rescreening.
RESULTS
We estimate that by annually screening 7.5% of the AA male population in the age-range, the chlamydia prevalence would be reduced relatively by 8.1% (95% CI 5.9% to 10.4%) in AA women and 8.8% (95% CI 6.9% to 10.8%) in AA men. Each man screened could prevent 0.062 (95% CI 0.030 to 0.094) cases in men and 0.204 (95% CI 0.143 to 0.267) cases in women. The model suggested the importance of intervention components ranked from high to low as venue-based screening, expedited index treatment, expedited partner treatment and rescreening.
CONCLUSION
The findings indicated that male-screening has the potential to substantially reduce the prevalence among women in high-prevalence communities.
目的
沙眼衣原体（Ct）感染是美国报告最多的性传播感染，会导致女性出现严重的生殖系统疾病。疾病控制与预防中心建议对25岁以下有性行为的女性进行常规筛查，但不包括男性。尽管对女性进行了三十年的筛查，但女性衣原体感染率仍然很高。未经检测和治疗的男性可能成为女性感染源，基于男性筛查的干预措施可能是降低女性感染率的有效策略。我们评估了男性筛查对女性沙眼衣原体感染率的影响。
设计
我们创建了一个基于个体的网络模型，以模拟一个合成人群（n = 5000）的性接触网络上真实的衣原体疫情。该模型根据美国非裔（AA）女性正在进行的常规筛查进行校准，并详细介绍了一个男性筛查项目“检查它”，该项目汇总了控制沙眼衣原体的最佳做法。我们使用敏感性分析来量化每个干预组成部分的相对重要性。
地点
美国路易斯安那州新奥尔良市的社区场所。
参与者
年龄在15至24岁之间、在过去两个月内与女性发生过性行为的异性恋非裔男性。
干预措施
基于场所的筛查、加速索引治疗、加速性伴治疗和重新筛查。
结果
我们估计，通过每年对该年龄范围内7.5%的非裔男性人群进行筛查，非裔女性的衣原体感染率将相对降低8.1%（95%可信区间5.9%至10.4%），非裔男性的感染率将降低8.8%（95%可信区间6.9%至10.8%）。每筛查一名男性可预防男性0.062例（95%可信区间0.030至0.094）感染和女性0.204例（95%可信区间0.143至0.267）感染。模型显示干预组成部分的重要性从高到低依次为基于场所的筛查、加速索引治疗、加速性伴治疗和重新筛查。
结论
研究结果表明，男性筛查有可能大幅降低高感染率社区中女性的感染率。
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