The Cost-Effectiveness of Syphilis Screening Among Men Who Have Sex With Men: An Exploratory Modeling Analysis

Chesson, Harrell W.; Kidd, Sarah; Bernstein, Kyle T.; Fanfair, Robyn Neblett; Gift, Thomas L.

doi:10.1097/olq.0000000000000461

Cited by 11 publications

(8 citation statements)

References 20 publications

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“…Such combination interventions generally include voluntary male circumcision, behaviour change (which generally includes emphasis on detection and treatment of STIs), and ART used as “treatment as prevention” (TaSP) or PrEP. Chesson and coworkers have argued that gonorrhoea, chlamydia and syphilis contribute to the HIV epidemic, and that their treatment may be a cost effective way to reduce the spread of HIV . However, as indicated above, mass treatment of STIs did not have the benefits anticipated in these models.…”

Section: Discussionmentioning

confidence: 99%

Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy

2019

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Introduction HIV is a unique sexually transmitted infection (STI) that is greatly affected by other concomitant “classical” bacterial and viral STIs that cause genital ulcers and/or mucosal inflammation. STIs also serve as a marker for risky sexual behaviours. STIs increase infectiousness of people living with HIV by increasing the viral concentration in the genital tract, and by increasing the potential for HIV acquisition in people at risk for HIV. In addition, some STIs can increase blood HIV concentration and promote progression of disease. This review is designed to investigate the complex relationship between HIV and classical STIs. Discussion Treatment of STIs with appropriate antibiotics reduces HIV in blood, semen and female genital secretions. However, community‐based trials could not reliably reduce the spread of HIV by mass treatment of STIs. Introduction of antiretroviral agents for the treatment and prevention of HIV has led to renewed interest in the complex relationship between STIs and HIV. Antiretroviral treatment (ART) reduces the infectiousness of HIV and virtually eliminates the transmission of HIV in spite of concomitant or acquired STIs. However, while ART interrupts HIV transmission, it does not stop intermittent shedding of HIV in genital secretions. Such shedding of HIV is increased by STIs, although the viral copies are not likely replication competent or infectious. Pre‐exposure prophylaxis (PrEP) of HIV with the combination of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) prevents HIV acquisition in spite of concomitant STIs. Conclusions STIs remain pandemic, and the availability of ART may have led to an increase in STIs, as fear of HIV has diminished. Classical STIs present a huge worldwide health burden that cannot be separated from HIV, and they deserve far more attention than they currently receive.

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Section: Discussionmentioning

confidence: 99%

Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy

2019

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“…The study limitations include modeling urogenital and rectal NG and CT infections (along with HIV) but no other STIs among MSM, such as syphilis [38]. Syphilis incidence has increased among US MSM over the past 5 years [39], but rates are still substantially lower than GC and CT incidence according to case surveillance data as well as comparisons in the PrEP metaanalysis, where NG/CT incidence was 6 times higher than syphilis in the non-PrEP cohorts and 3 times higher in the PrEP cohorts.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Gonorrhea and Chlamydia Following Human Immunodeficiency Virus Preexposure Prophylaxis Among Men Who Have Sex With Men: A Modeling Study

Jenness

Weiss

Goodreau

et al. 2017

Clinical Infectious Diseases

200

165

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“…High extragenital NG and CT prevalence among community-sampled MSM suggests that the general population of sexually active MSM, not just high-risk MSM attending STD clinics, might be at elevated risk for STI acquisition [10]. Previous studies have explored the importance of targeted STI screening, as financial resources limit the ability to screen the entire population [15, 28, 32]. Increasing the partner threshold for more frequent screening with fixed coverage above 3 partners lessened the detection and treatment of asymptomatic cases, resulting in a reduced population-level PIA as the size of the higher-frequency screening group decreased.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Coverage vs Frequency for Sexually Transmitted Infection Screening of Men Who Have Sex With Men

Weiss

Jones

Anderson

et al. 2019

Open Forum Infectious Diseases

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Background The incidence of bacterial sexually transmitted infections (STIs) in men who have sex with men (MSM) has increased substantially despite availability of effective antibiotics. The US Centers for Disease Control and Prevention (CDC) recommends annual screening for all sexually active (SA) MSM and more frequent screening for high-risk (HR) MSM. The population-level benefits of improved coverage vs increased frequency of STI screening among SA vs HR MSM are unknown. Methods We used a network transmission model of gonorrhea (NG) and chlamydia (CT) among MSM to simulate the implementation of STI screening across different scenarios, starting with the CDC guidelines at current coverage levels. Counterfactual model scenarios varied screening coverage and frequency for SA MSM and HR MSM (MSM with multiple recent partners). We estimated infections averted and the number needed to screen to prevent 1 new infection. Results Compared with current recommendations, increasing the frequency of screening to biannually for all SA MSM and adding some HR screening could avert 72% of NG and 78% of CT infections over 10 years. Biannual screening of 30% of HR MSM at empirical coverage levels for annual SA screening could avert 76% of NG and 84% of CT infections. Other scenarios, including higher coverage among SA MSM and increasing frequency for HR MSM, averted fewer infections but did so at a lower number needed to screen. Conclusions The optimal screening scenarios in this model to reduce STI incidence among MSM included more frequent screening for all sexually active MSM and higher coverage of screening for HR men with multiple partners.

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The Cost-Effectiveness of Syphilis Screening Among Men Who Have Sex With Men: An Exploratory Modeling Analysis

Abstract: We adapted a published model to estimate the costs and benefits of screening men who have sex with men for syphilis, including the benefits of preventing syphilis-attributable human immunodeficiency virus. The cost per quality-adjusted life year gained by screening was

Cited by 11 publications

References 20 publications

Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy

Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy

Incidence of Gonorrhea and Chlamydia Following Human Immunodeficiency Virus Preexposure Prophylaxis Among Men Who Have Sex With Men: A Modeling Study

Optimizing Coverage vs Frequency for Sexually Transmitted Infection Screening of Men Who Have Sex With Men

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