The Impact of Syphilis Screening among Female Sex Workers in China: A Modelling Study.


Mitchell, KM; Cox, AP; Mabey, D; Tucker, JD; Peeling, RW; Vickerman, P; (2013) The Impact of Syphilis Screening among Female Sex Workers in China: A Modelling Study. PLoS One, 8 (1). e55622. ISSN 1932-6203 DOI: https://doi.org/10.1371/journal.pone.0055622

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Abstract

BACKGROUND In China, female sex workers (FSWs) are at high risk of syphilis infection, but are hard to reach for interventions. Point-of-care testing introduces opportunities for expanding syphilis control measures. Modelling is used to estimate the impact of using rapid tests to screen FSWs for syphilis. In other settings, modelling has predicted large rebounds in infectious syphilis following screening, which may undermine any impact achieved. METHODS A deterministic syphilis transmission model among FSWs and clients was fitted to data from Yunnan Province (FSW syphilis prevalence = 7.5%), and used to estimate the impact of rapid syphilis testing and treatment for FSWs. Impact projections were compared for different model structures that included risk heterogeneity amongst FSWs, incoming syphilis infections amongst new FSWs and clients and re-infection from FSWs' regular non-commercial partners. The rebound in syphilis prevalence after screening ceased was explored. RESULTS All model structures suggest yearly syphilis screening could substantially reduce (by 72-88%) syphilis prevalence amongst FSWs in this setting over five years. However, incoming syphilis infections amongst new FSWs and clients or re-infections from regular non-commercial partners of FSWs can considerably reduce (>30%) the proportion of infections averted. Including heterogeneity in risk amongst FSWs had little effect upon the proportion of infections averted. In this setting, the rebound in syphilis prevalence after screening ceased is predicted to be slight, but it could be large in high prevalence settings. CONCLUSIONS Rapid test screening could dramatically reduce syphilis prevalence amongst hard-to-reach groups, but strategies to reduce re-infection from regular non-commercial partners are needed to maximise impact.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
Social and Mathematical Epidemiology (SaME)
SaME Modelling & Economics
PubMed ID: 23383249
Web of Science ID: 315563800176
URI: http://researchonline.lshtm.ac.uk/id/eprint/613554

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