Changes in chlamydia prevalence and duration of infection estimated from testing and diagnosis rates in England: a model-based analysis using surveillance data, 2000-15
Changes in chlamydia prevalence and duration of infection estimated from testing and diagnosis rates in England: a model-based analysis using surveillance data, 2000-15
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DOI：
10.1016/s2468-2667(18)30071-9
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发表时间：
2018-06-01
影响因子：
50
通讯作者：
White, Peter J.
中科院分区：
文献类型：
--
作者：
Lewis, Joanna;White, Peter J.
衣原体筛查项目已在一些国家实施，但筛查对发病率、患病率和生殖后遗症的影响尚不清楚。在英格兰，尽管随着国家衣原体筛查计划（NCSP; 2003-08）的推出，检测增加，但在10年一次的基于人口的调查中估计的患病率在该计划之前（1999-2001年）和之后（2010-12年）相似。然而，这些先前估计的精确度受到感染人数少的限制。我们的目的是建立每年，而不是10年，估计衣原体的患病率和感染despion.Methods在这个模型为基础的analysis，我们使用以前公布的最低和最高估计和公共卫生英格兰数据的衣原体测试覆盖率和诊断年龄在15-24岁的男性和女性在英格兰，之前，期间，和之后扩大国家衣原体筛查。我们使用了一个机制模型，该模型考虑了有症状的衣原体检测和无症状的筛查，以估计每年感染率和平均持续时间的变化。我们描述的估计来自最大和最小数量的测试和诊断的最大和最小estimates，无论其相对magnitude.Findings的数据包括测试和诊断的男性和女性年龄在15-19岁和20-24岁，每年在英格兰从2000年至2015年。我们估计，一旦全面实施筛查，男女的患病率和平均感染持续时间都会降低。从2008年到2010年，估计15-24岁人群的后验中位数患病率下降了0.68个百分点（95%可信区间0.26-1.40;最小值）和0.66个百分点（0.25-1.37;最大值），妇女为0.77个百分点（0.45-1.27）（妇女的最小和最大估计值相同）。在同一时期，男性的平均感染持续时间减少了75天（95%可信区间17-255;最小值）和74天（95%可信区间17-247;最大值），女性减少了30天（22-40）。自2010年以来，NCSP取得的一些进展已经逆转，同时减少了检测。解释我们的分析提供了第一个证据，证明在英格兰大规模人群检测的同时，衣原体患病率下降。它还显示了感染的平均持续时间的持续下降，这是一个衡量筛查有效性的指标，不受行为变化的影响。资助国家卫生研究所，医学研究理事会。版权所有（c）2018作者。由Elsevier Ltd.出版。这是一篇开放获取文章，使用CC BY 4.0许可证。
Background Chlamydia screening programmes have been implemented in several countries, but the effects of screening on incidence, prevalence, and reproductive sequelae remain unclear. In England, despite increases in testing with the rollout of the National Chlamydia Screening Programme (NCSP; 2003-08), prevalence estimated in 10-yearly population-based surveys was similar before (1999-2001) and after (2010-12) the programme. However, the precision of these previous estimates was limited by the low numbers of infections. We aimed to establish annual, rather than 10-yearly, estimates of chlamydia prevalence and infection duration.Methods In this model-based analysis, we used previously published minimum and maximum estimates and Public Health England data for chlamydia test coverage and diagnoses in men and women aged 15-24 years in England, before, during, and after the scale-up of national chlamydia screening. We used a mechanistic model, which accounted for symptomatic chlamydia testing and asymptomatic screening, to estimate changes in prevalence and average duration of infections for each year. We describe estimates derived from the maximum and minimum numbers of tests and diagnoses as maximum and minimum estimates, regardless of their relative magnitude.Findings The data included numbers of tests and diagnoses in men and women aged 15-19 years and 20-24 years in England each year from 2000 to 2015. We estimated reductions in prevalence and average infection duration in both sexes once screening was fully implemented. From 2008 to 2010, estimated posterior median prevalence reductions in people aged 15-24 years were 0.68 percentage points (95% credible interval 0.26-1.40; minimum) and 0.66 percentage points (0.25-1.37; maximum) for men and 0.77 percentage points (0.45-1.27) for women (minimum and maximum estimates were the same for women). Over the same time period, mean duration of infection reduced by 75 days (95% credible interval 17-255; minimum) and 74 days (95% credible interval 17-247; maximum) in men and 30 days (22-40) in women. Since 2010, some of the progress made by the NCSP has been reversed, alongside a reduction in testing.Interpretation Our analysis provides the first evidence for a reduction in chlamydia prevalence in England concurrent with large-scale population testing. It also shows a consistent decline in the average duration of infections, which is a measure of screening effectiveness that is unaffected by behavioural changes.Funding National Institute for Health Research, Medical Research Council. Copyright (c) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.