Strategic options for syphilis control in Papua New Guineae impact and cost-effectiveness projections using the syphilis interventions towards elimination (SITE) model  

作　　者：Shepherd Machekera Peniel Boas Poruan Temu Zimmbodilion Mosende Namarola Lote Angela Kelly-Hanku S.Guy Mahiane Robert Glaubius Jane Rowley Anup Gurung Eline Korenromp 

机构地区：[1]Government of Papua New Guinea,National Department of Health,AOPI Center,Waigani Drive,PO Box,5896,Port Moresby,Papua New Guinea [2]World Vision International,Ruta Place,Morata St,Gordons.P.O Box 4254,Boroko,National Capital District,Port Moresby,Papua New Guinea [3]UNAIDS Papua New Guinea Country Office,Port Moresby,Papua New Guinea [4]WHO Papua New Guinea Country Office,Communicable Disease&Health Emergency Dept.,AOPI Centre,Waigani Drive,Port Moresby,Papua New Guinea [5]Papua New Guinea Institute of Medical Research,441 Homate Street,PO Box 60,Goroka,Eastern Highland Province,Papua New Guinea [6]Kirby Institute,UNSW Sydney,Wallace Wurth Building,High Street,UNSW Australia Kensington,NSW 2052,Sydney,Australia [7]Avenir Health,Modelling,Planning and Policy Analysis Dept.,655 Winding Brook Drive,Glastonbury,CT,06033,USA [8]Independent Consultant,135 Gloucester Terrace,W26DX,London,UK [9]Avenir Health,Modelling,Planning and Policy Analysis Dept.,150 Route de Ferney,PO box 2100,CH-1211 Geneva 2,Switzerland

出　　处：《Infectious Disease Modelling》2021年第1期584-597,共14页传染病建模（英文）

基　　金：Financial support for this work was provided by the World Health Organization(WHO)PNG Country Office.

摘　　要：Objectives:Papua New Guinea(PNG)has among the highest rates of sexually transmitted infections(STIs)globally and is committed to reducing their incidence.The Syphilis Interventions Towards Elimination(SITE)model was used to explore the expected impact and cost of alternative syphilis intervention scale-up scenarios.Methods:SITE is a dynamical model of syphilis transmission among adults 15-49 years.Individuals are divided into nine groups based on sexual behaviour and into six stages of infection.The model was calibrated to PNG using data from routine surveillance,biobehavioural surveys,research studies and program records.Inputs included syphilis prevalence,risk behaviours,intervention coverage and service delivery unit costs.Scenarios compared different interventions(clinical treatment,contact tracing,syphilis screening,and condom promotion)for incidence and cost per infection averted over 2021-2030.Results:Increasing treatment coverage of symptomatic primary/secondary-stage syphilis cases from 25-35%in 2020 to 60%from 2023 onwards reduced estimated incidence over 2021-2030 by 55%,compared to a scenario assuming constant coverage at 2019-2020 levels.The introduction of contact tracing in 2020,assuming 0.4 contacts per symptomatic person treated,reduced incidence over 2021-2030 by 10%.Increasing screening coverage by 20-30 percentage points from the 2019-2020 level reduced incidence over 2021-2030 by 3e16%depending on the target population.Scaling-up clinical,symptom-driven treatment and contact tracing had the lowest cost per infection averted,followed by condom promotion and periodic screening of female sex workers and men who have sex with men.Conclusions:PNG could considerably reduce its syphilis burden by scaling-up clinical treatment and contact tracing alongside targeted behavioural risk reduction interventions.SITE is a useful tool countries can apply to inform national STI programming and resource allocation.

关 键 词：SYPHILIS Prevention Treatment COST-EFFECTIVENESS Resource allocation National program strategy 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]