Rönn Minttu M, Chesson Harrell W, Grad Yonatan H, Reitsma Marissa, Zhu Lin, Hsu Katherine, Gift Thomas L, Salomon Joshua A
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
J Infect Dis. 2025 Aug 14;232(2):e266-e274. doi: 10.1093/infdis/jiaf206.
Limited estimates exist on the population-level impact of partner notification (PN) for gonorrhea, with uncertainty in the influence of local epidemiology on PN effectiveness. An ecologic study in New York found a 6% reduction in diagnoses with a 10% increase in PN coverage. We estimated gonorrhea incidence reductions via PN across different epidemiologic conditions to compare the effects with the prior finding and to understand key determinants of variation.
We developed a stochastic network model of men who have sex with men and calibrated gonorrhea transmission dynamics to varied epidemiologic conditions. The population-level impact of increasing PN was summarized by incidence rate ratios (IRRs), and the relative importance of explanatory variables (including network density, baseline burden, and natural history parameters) was assessed via linear regression modeling of IRR and bootstrapping to evaluate uncertainty in estimation.
We estimated an IRR of 0.97 (95% range, 0.93-0.99) for a 10% relative increase in PN coverage, comparable to the IRR of 0.94 (0.91-0.97) identified in the empirical study. PN retained effectiveness under diverse epidemiologic conditions. In a univariate sensitivity analysis, the strongest influence on IRR came from parameters governing index case testing probability, with an IRR of 0.93 when testing was at its highest. Other factors, such as network density, baseline incidence, and various natural history parameters, had relatively minor effects on the IRR. We observed larger individual-level benefits from PN for individuals with higher numbers of partners.
Our findings support prior population-level estimates of the impact of PN on gonorrhea incidence.
关于淋病性伴侣通知（PN）对人群层面的影响，现有估计有限，且当地流行病学对PN有效性的影响尚不确定。纽约的一项生态学研究发现，随着PN覆盖率提高10%，淋病诊断率降低了6%。我们估计了在不同流行病学条件下通过PN实现的淋病发病率降低情况，以将结果与先前的研究结果进行比较，并了解变异的关键决定因素。
我们建立了一个男男性行为者的随机网络模型，并将淋病传播动态校准到不同的流行病学条件。通过发病率比（IRR）总结增加PN的人群层面影响，并通过对IRR进行线性回归建模和自抽样评估解释变量（包括网络密度、基线负担和自然史参数）的相对重要性，以评估估计中的不确定性。
我们估计，PN覆盖率相对增加10%时，IRR为0.97（95%范围为0.93 - 0.99），与实证研究中确定的IRR 0.94（0.91 - 0.97）相当。在不同的流行病学条件下，PN均保持有效性。在单变量敏感性分析中，对IRR影响最大的是控制索引病例检测概率的参数，检测概率最高时IRR为0.93。其他因素，如网络密度、基线发病率和各种自然史参数，对IRR的影响相对较小。我们观察到，PN对性伴侣较多的个体有更大的个体层面益处。
我们的研究结果支持先前关于PN对淋病发病率影响的人群层面估计。
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