Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000–2016: Estimates using the Spectrum STI tool

Enkhbat, Erdenetungalag; Korenromp, Eline L.; Badrakh, Jugderjav; Zayasaikhan, Setsen; Baya, Purevsuren; Orgiokhuu, Enkhjargal; Jadambaa, Narantuya; Munkhbaatar, Sergelen; Khishigjargal, Delgermaa; Khad, Narantuya; Mahiané, Guy; Ishikawa, Naoko; Jagdagsuren, Davaalkham; Taylor, Melanie

doi:10.1016/j.idm.2018.03.003

Cited by 10 publications

(10 citation statements)

References 21 publications

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“…Spectrum-STI fits a time trend through prevalence data, applying segmented polynomial regression (13, 14) using second-order splines constrained in a 0%-20% prevalence range, with knots positioned at five-year intervals (7). Eligible data were from surveys of women in ANC, routine ANC-based syphilis screening, and representative general population surveys.…”

Section: Methodsmentioning

confidence: 99%

“…This was the first-ever calculation of the national adult STI burden in Colombia, and the first application of the Spectrum-STI model in a country in the Americas. The article also describes using the estimated prevalence of syphilis in adult women to estimate congenital syphilis (CS) incidence and associated adverse birth outcomes (ABOs) (3-7). These estimates aim to assist in strengthening Colombia's national STI surveillance and control efforts.…”

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confidence: 99%

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Prevalence and incidence estimates for syphilis, chlamydia, gonorrhea, and congenital syphilis in Colombia, 1995–2016

Korenromp¹,

Rios

Apolinar³

et al. 2018

Rev Panam Salud Publica

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Objectives To estimate adult (15–49 years old) prevalence and incidence of active syphilis, gonorrhea, and chlamydia, and incidence of congenital syphilis (CS) and adverse birth outcomes (ABOs) in Colombia, over 1995–2016. Methods The Spectrum-STI epidemiological model tool estimated gonorrhea and chlamydia prevalences as moving averages across prevalences observed in representative general population surveys. For adult syphilis, Spectrum-STI applied segmented polynomial regression through prevalence data from antenatal care (ANC) surveys, routine ANC-based screening, and general population surveys. CS cases and ABOs were estimated from Spectrum's maternal syphilis estimates and proportions of women screened and treated for syphilis, applying World Health Organization case definitions and risk probabilities. Results The Spectrum model estimated prevalences in 2016 of 0.70% (95% confidence interval (CI): 0.15%-1.9%) in women and 0.60% (0.1%-1.9%) in men for gonorrhea and of 9.2% (4.4%-15.4%) in women and 7.4% (3.5%-14.7%) in men for chlamydia, without evidence for trends over 1995–2016. The prevalence of active syphilis in 2016 was 1.25% (1.22–1.29%) in women and 1.25% (1.1%-1.4%) in men, decreasing from 2.6% (2.1%-3.2%) in women in 1995. Corresponding CS cases in 2016 (including cases without clinical symptoms) totaled 3 851, of which 2 245 were ABOs. Annual CS and ABO estimates decreased over 2008–2016, reflecting decreasing maternal prevalence and increasing cases averted through ANC-based screening and treatment. Conclusions The available surveillance and monitoring data synthesized in Spectrum-STI— and the resulting first-ever national STI estimates for Colombia—highlighted Colombia's persistently high STI burden. Adult syphilis and congenital syphilis are estimated to be falling, reflecting improving screening efforts. Strengthened surveillance, including with periodic screening in low-risk populations and future refined Spectrum estimations, should support planning and implementation of STI prevention and control, including CS elimination.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Prevalence and incidence estimates for syphilis, chlamydia, gonorrhea, and congenital syphilis in Colombia, 1995–2016

Korenromp¹,

Rios

Apolinar³

et al. 2018

Rev Panam Salud Publica

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“…The 2017 syphilis prevalence estimate in Yunnan for women 15 to 49 was 0.26% (0.17-0.34%) and for men 0.28% (0.20-0.36%). These levels are low compared to other East and Central Asia countries 15 , and relative to countries with similar per capita incomes [34][35][36] . Given the low prevalence, Yunnan is in a position where it could meet the WHO criteria for eliminating congenital syphilis, provided coverages of ANC attendance, of ANC-based syphilis screening and of syphilis treatment among women diagnosed during ANC are all 95% or higher 37 .…”

Section: Discussionmentioning

confidence: 99%

“…We also looked at the effect of changing the relative population sizes of FSW and MSM, using UNAIDS regional estimates for Asia or all low-and middle-income countries 9,14 instead of Yunnan's population size estimates. More general assumptions underlying the Spectrum-STI model have been addressed in sensitivity analyses in earlier publications 3,4,15 .…”

Section: Sensitivity Analysis Univariate Sensitivity Analyses Lookedmentioning

confidence: 99%

“…Prevalence data from each study were standardized before trend fitting to ensure that they reflected active syphilis, the stage relevant for disease transmission, defined as concurrent positivity on both a non-treponemal (e.g., Rapid Plasma Reagin (RPR) or Venereal Disease Research Laboratory (VDRL) test) and a treponemal test. This adjustment used the same approach and 15 3 ,241 0.46 25 3 2,702 0.11 25 12 3,215 0.37 25 0 3,041 0.00 25 4 1,599 0.25 25 5 1,600 0 4,12,13 . For lower-risk men and women each study was assigned a weight reflecting how representative it was of the particular population group (Table 1).…”

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The Spectrum-STI Groups model: syphilis prevalence trends across high-risk and lower-risk populations in Yunnan, China

Korenromp¹,

Zhang

et al. 2020

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Spectrum-Sti model, structured by subgroups within a population, was used in a workshop in Yunnan, China, to estimate provincial trends in active syphilis in 15 to 49-year-old adults. Syphilis prevalence data from female sex workers (fSW), men who have sex with men (MSM), and lower-risk women and men in Yunnan were identified through literature searches and local experts. Sources included antenatal care clinic screening, blood donor screening, HiV/Sti bio-behavioural surveys, sentinel surveillance, and epidemiology studies. The 2017 provincial syphilis prevalence estimates were 0.26% (95% confidence interval 0.17-0.34%) in women and 0.28% (0.20-0.36%) in men. Estimated prevalence was 6.8-fold higher in FSW (1.69% (0.68-3.97%) than in lower-risk women (0.25% (0.18-0.35%)), and 22.7-fold higher in MSM (5.35% (2.74-12.47%) than in lower-risk men (0.24% (0.17-0.31%). For all populations, the 2017 estimates were below the 2005 estimates, but differences were not significant. In 2017 FSW and MSM together accounted for 9.3% of prevalent cases. These estimates suggest Yunnan's Sti programs have kept the overall prevalence of syphilis low, but prevalence remains high in FSW and MSM. Strengthening efforts targeting FSW and MSM, and identification of other risk populations e.g. among heterosexual men, are critical to reduce syphilis. Spectrum-STI is a statistical trend-fitting model designed for countries to estimate trends over time in the prevalence and incidence of three sexually transmitted infections (STIs): syphilis (etiologic agent: Treponema pallidum subspecies pallidum); gonorrhea (Neisseria gonorrhoeae); and chlamydia (Chlamydia trachomatis) from available prevalence data after standardizing for diagnostic test, location and age and weighted to reflect representativeness. The model builds on the Spectrum suite of health policy planning and surveillance models developed by Avenir Health 1. The latest version of Spectrum-STI, the Spectrum-STI Groups model, allows for estimates to be generated for different higher-risk and lower-risk groups in a population and for these to be combined to form an overall population estimate. In November 2018, Spectrum-STI Groups was piloted in a 3-day workshop held in Kunming, Yunnan's capital, organized by the Yunnan provincial Center for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Yunnan province is located in the southwest of China and in 2017 had a population of just under 46 million (3.4% of China's population). It is one of three provinces chosen by China's National Health and Family Commission and UNICEF to pilot validating elimination of mother-to-child transmission of HIV, syphilis and

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Syphilis prevalence trends in adult women in 132 countries – estimations using the Spectrum Sexually Transmitted Infections model

Korenromp¹,

Mahiane

Nagelkerke

et al. 2018

Sci Rep

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We estimated national-level trends in the prevalence of probable active syphilis in adult women using the Spectrum Sexually Transmitted Infections (STI) model to inform program planning, target-setting, and progress evaluation in STI control. The model fitted smoothed-splines polynomial regressions to data from antenatal clinic surveys and screening and representative household surveys, adjusted for diagnostic test performance and weighted by national coverage. Eligible countries had ≥1 data point from 2010 or later and ≥3 from 2000 or later from adult populations considered representative of the general female population (pregnant women or community-based studies). Between 2012 and 2016, the prevalence of probable active syphilis in women decreased in 54 (41%) of 132 eligible countries; this decrease was substantive (≥10% proportionally, ≥0.10% percentage-point absolute difference and non-overlapping 95% confidence intervals in 2012 and 2016) in 5 countries. Restricting eligible data to prevalence measurements of dual treponemal and non-treponemal testing limited estimates to 85 countries; of these, 45 countries (53%) showed a decrease. These standardized trend estimates highlight the need for increased investment in national syphilis surveillance and control efforts if the World Health Organization target of a 90% reduction in the incidence of syphilis between 2018 and 2030 is to be met.

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Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000–2016: Estimates using the Spectrum STI tool

Cited by 10 publications

References 21 publications

Prevalence and incidence estimates for syphilis, chlamydia, gonorrhea, and congenital syphilis in Colombia, 1995–2016

Prevalence and incidence estimates for syphilis, chlamydia, gonorrhea, and congenital syphilis in Colombia, 1995–2016

The Spectrum-STI Groups model: syphilis prevalence trends across high-risk and lower-risk populations in Yunnan, China

Syphilis prevalence trends in adult women in 132 countries – estimations using the Spectrum Sexually Transmitted Infections model

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