Estimating prevalence trends in adult gonorrhoea and syphilis in low- and middle-income countries with the Spectrum-STI model: results for Zimbabwe and Morocco from 1995 to 2016

Korenromp, Eline L.; Mahiané, Guy; Rowley, J; Nagelkerke, Nico; Abu‐Raddad, Laith J.; Ndowa, Francis; El-Kettani, Amina; El-Rhilani, Houssine; Mayaud, Philippe; Chico, R Matthew; Pretorius, Carel; Hecht, Kendall; Wi, Teodora

doi:10.1136/sextrans-2016-052953

Cited by 36 publications

(69 citation statements)

References 31 publications

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“…The summarised and studyspecific risk of bias and precision assessments are shown in the appendix (pp [15][16][17][18][19][20][21][22][23][24][25][26][27] Table 3 shows the metaanalyses' results for the pooled average C trachomatis prevalence for each atrisk popula tion, stratified by type of assay used for infection ascertain ment. Current infection prevalence was estimated at 3•0% (table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Studies applying nucleic acid amplification test (NAAT) and culture to the same biological specimen were included separately given our interest in studying their contribution to hetero geneity in C trachomatis prevalence, and in generating STIestimation correction factors based on assay type. [23][24][25] Studies applying other antigen detection assays to the same biological specimen were included only once based on assay sensitivity (direct fluorescence and enzyme linked immunoassays on genital samples were prioritised over Giemsa staining).…”

Section: Implications Of All the Available Evidencementioning

confidence: 99%

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Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression

Smolak

Chemaitelly

Hermez

et al. 2019

The Lancet Global Health

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Background The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. Methods We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of betweenstudy heterogeneity were determined using meta-regression. Findings We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3•0% (95% CI 2•3-3•8) in general populations, 2•8% (1•0-5•2) in intermediate-risk populations, 13•2% (7•2-20•7) in female sex workers, 11•3% (9•0-13•7) in infertility clinic attendees, 12•4% (7•9-17•7) in women with miscarriage, 12•4% (9•4-15•7) in symptomatic women, and 17•4% (12•5-22•8) in symptomatic men. Pooled prevalence of current rectal infection was 7•7% (4•2-12•0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29•0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. Interpretation C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region.

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Section: Resultsmentioning

confidence: 99%

Section: Implications Of All the Available Evidencementioning

confidence: 99%

Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression

Smolak

Chemaitelly

Hermez

et al. 2019

The Lancet Global Health

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“…In a recent WHO survey, about 1 million pregnant women were reported to have active Treponemal infection constituting a 1% prevalence [5] while among blood donors, an estimated 1.6 million units of blood were discarded due to the presence of infectious markers including treponematoses [6]. In Africa, Treponemal infection in women of reproductive age group is reported to range from 0.36% to 3.6% [7] whereas rates ranging from 0.71% to 20% have been recorded among blood donors [8,9]. In Ghana, previous studies undertaken to establish national representative data of Treponemal infection among pregnant women and apparently healthy blood donors revealed prevalence rates of 0.3% and 3.7% among the respective populations [10,11].…”

Section: Introductionmentioning

confidence: 99%

A comparative study of the epidemiology of Treponemal Infection in the Volta Region of Ghana: A Five-Year Multisite Parallel Population-Based Analysis vis-à-vis the Sentinel Survey

Lokpo

Owusu‐Dabo

Deku

et al. 2019

Preprint

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Background: Treponemal infection is contagious and one of the oldest blood-borne infections, with great public health consequences. This study aimed to comparatively describe the five-year (2013-2017) regional epidemiology of Treponemal infection using pregnant women in the Sentinel Survey and apparently healthy blood donors as proxy for the general population at the four sentinel sites in the Volta Region of Ghana. Method: We analysed retrospectively data from 17,744 prospective blood donors aged between 18 to 58 years and 7,805 pregnant women in a Sentinel Survey who fell within the 15 and 49 years age bracket at Hohoe, Ho, Tongu and Krachi-West sentinel sites in the Volta Region. Data extracted included age, gender, date of blood donation and Treponena pallidum chromatographic immunoassay results from the blood banks of the four study sites.Published reports of Sentinel Surveys conducted at the four sentinel sites from the years 2013-2017 were retrieved. Results: The cumulative five-year prevalence of Treponemal infections among the pregnant women in the Sentinel Survey and prospective blood donors was 0.38% and 2.38% respectively. Site-specific prevalence for population-base/Sentinel survey was 4.6%/0.4%, 2.0%/0.2%, 1.3%/0.8 and 1.2%/0.2 for Hohoe, Ho, Krachi-West and Tongu respectively. Treponemal infection rates among the younger age groups (15-24years) were 0.31% in the sentinel survey and 2.22% in the general population. Significant gender disparity in Treponemal infection exist with male preponderance. Conclusion: The regional prevalence of Treponemal infection in the Sentinel Survey is lower compared to the general population. Therefore, the use of pregnant women as proxy for population estimate could lead to underestimation of the burden in the study jurisdiction.

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“…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%

“…Spectrum-Sti model. Spectrum-STI is a statistical model that fits time trends in national or provincial adult STI prevalence and incidence, based on STI prevalence data 3,4 . In the fall of 2018, the model was expanded to incorporate different population groups (Spectrum-STI versions 5.73 and onwards) and is available online (https://avenirhealth.org/software-spectrum.php).…”

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confidence: 99%

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

Korenromp¹,

Zhang

et al. 2020

Sci Rep

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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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Estimating prevalence trends in adult gonorrhoea and syphilis in low- and middle-income countries with the Spectrum-STI model: results for Zimbabwe and Morocco from 1995 to 2016

Cited by 36 publications

References 31 publications

Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression

Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression

A comparative study of the epidemiology of Treponemal Infection in the Volta Region of Ghana: A Five-Year Multisite Parallel Population-Based Analysis vis-à-vis the Sentinel Survey

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

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