The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
Sex Transm Infect. 2022 Sep;98(6):414-419. doi: 10.1136/sextrans-2021-055220. Epub 2021 Nov 23.
The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a cluster randomised controlled trial designed to assess the effectiveness of annual chlamydia testing through general practice in Australia. The trial showed that testing rates increased among sexually active men and women aged 16-29 years, but after 3 years the estimated chlamydia prevalence did not differ between intervention and control communities. We developed a mathematical model to estimate the potential longer-term impact of chlamydia testing on prevalence in the general population.
We developed an individual-based model to simulate the transmission of in a heterosexual population, calibrated to ACCEPt data. A proportion of the modelled population were tested for chlamydia and treated annually at coverage achieved in the control and intervention arms of ACCEPt. We estimated the reduction in chlamydia prevalence achieved by increasing retesting and by treating the partners of infected individuals up to 9 years after introduction of the intervention.
Increasing the testing coverage in the general Australian heterosexual population to the level achieved in the ACCEPt intervention arm resulted in reduction in the population-level prevalence of chlamydia from 4.6% to 2.7% in those aged 16-29 years old after 10 years (a relative reduction of 41%). The prevalence reduces to 2.2% if the proportion retested within 4 months of treatment is doubled from the rate achieved in the ACCEPt intervention arm (a relative reduction of 52%), and to 1.9% if the partner treatment rate is increased from 30%, as assumed in the base case, to 50% (a relative reduction of 59%).
A reduction in prevalence could be achieved if the level of testing as observed in the ACCEPt intervention arm can be maintained at a population level. More substantial reductions can be achieved with intensified case management comprising retesting of those treated and treatment of partners of infected individuals.
澳大利亚衣原体控制效果试点（ACCEPT）是一项集群随机对照试验，旨在评估澳大利亚通过全科医生进行年度衣原体检测的效果。该试验表明，16-29 岁有性行为的男女检测率有所提高，但 3 年后，干预组和对照组社区的衣原体估计流行率没有差异。我们开发了一个数学模型来估计衣原体检测对普通人群流行率的潜在长期影响。
我们开发了一个基于个体的模型来模拟在异性恋人群中传播的情况，该模型根据 ACCEPT 数据进行了校准。模型中的一部分人群接受衣原体检测，并且按照 ACCEPT 对照组和干预组的覆盖率，每年接受一次治疗。我们估计通过增加重复检测和治疗感染个体的性伴侣，在干预措施引入后 9 年内，可降低衣原体流行率。
将普通澳大利亚异性恋人群的检测覆盖率提高到 ACCEPT 干预组的水平，可使 16-29 岁人群的人群水平衣原体流行率从 4.6%降低到 2.7%，10 年后相对降低 41%。如果将治疗后 4 个月内重复检测的比例从 ACCEPT 干预组的水平提高一倍，流行率可降低到 2.2%（相对降低 52%），如果将伴侣治疗率从 30%（基础病例中假设的水平）提高到 50%，流行率可降低到 1.9%（相对降低 59%）。
如果能将 ACCEPT 干预组观察到的检测水平维持在人群水平，就可以降低衣原体流行率。通过加强病例管理，包括对已治疗个体的重复检测和对感染个体的性伴侣的治疗，可以实现更大程度的降低。
