The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities – a mathematical modeling study

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2024-07-20 DOI:10.1016/j.lana.2024.100845

Yiqing Xia , Chelsea Caya , Véronique Morin , Ameeta E. Singh , Bouchra Serhir , Michael Libman , David M. Goldfarb , Tom Wong , Fanyu Xiu , Richard Bélanger , Jean-Sébastien Touchette , Cédric P. Yansouni , Mathieu Maheu-Giroux

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引用次数: 0

Abstract

Background

Canadian Arctic communities have experienced sustained syphilis transmission, with diagnoses rates 18-times higher than the national average. Remoteness from laboratory facilities leads to delays between syphilis screening and treatment, contributing to onward transmission. Rapid diagnostic tests can eliminate treatment delays via testing at the point-of-care. This study aims to describe syphilis diagnostic gaps and to estimate the impact of introducing rapid diagnostic tests at the point-of-care on syphilis transmission.

Methods

To assess the population-level impact of deploying rapid diagnostic tests, an individual-based model was developed using detailed surveillance data, population surveys, and a prospective diagnostic accuracy field study. The model was calibrated to syphilis diagnoses (2017–2022) from a community of approximately 1,050 sexually active individuals. The impacts of implementing rapid diagnostic tests using whole blood (sensitivity: 92% for infectious and 81% for non-infectious syphilis; specificity: 99%) from 2023 onward was calculated using the annual median fraction of cumulative new syphilis infections averted over 2023–2032.

Findings

The median modeled syphilis incidence among sexually active individuals was 44 per 1,000 in 2023. Males aged 16–30 years exhibited a 51% lower testing rate than that of their female counterparts. Maintaining all interventions constant at their 2022 levels, implementing rapid diagnostic tests could avert a cumulative 33% (90% credible intervals: 18–43%) and 37% (21–46%) of new syphilis infections over 5 and 10 years, respectively. Increasing testing rates and contact tracing may enhance the effect of rapid diagnostic tests.

Interpretation

Implementing rapid diagnostic tests for syphilis in Arctic communities could reduce infections and enhance control of epidemics. Such effective diagnostic tools could enable rapid outbreak responses by providing same-day testing and treatment at the point-of-care.

Funding

Canadian Institutes of Health Research.

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引入快速诊断测试对加拿大北极社区梅毒传播的人群影响--数学建模研究

背景加拿大北极地区的社区经历了梅毒的持续传播，诊断率比全国平均水平高出18倍。由于远离实验室设施，导致梅毒筛查和治疗之间出现延误，从而助长了梅毒的传播。快速诊断检测可以通过在医疗点进行检测消除治疗延误。为了评估部署快速诊断检测对人群的影响，我们利用详细的监测数据、人口调查和前瞻性诊断准确性实地研究，建立了一个基于个体的模型。该模型根据一个约有 1050 名性活跃人群的社区的梅毒诊断结果（2017-2022 年）进行了校准。利用 2023-2032 年间累计避免的梅毒新感染病例的年中位数，计算了从 2023 年起实施全血快速诊断检测的影响（感染性梅毒的灵敏度为 92%，非感染性梅毒的灵敏度为 81%；特异性为 99%）。16-30 岁男性的检测率比女性低 51%。在所有干预措施保持 2022 年水平不变的情况下，实施快速诊断检测可在 5 年和 10 年内分别避免 33% （90% 可信区间：18-43%）和 37% （21-46%）的梅毒新发感染。在北极社区实施梅毒快速诊断检测可减少感染并加强对流行病的控制。这种有效的诊断工具可以在护理点提供当天的检测和治疗，从而快速应对疫情。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.