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Screen more or screen more often? Using mathematical models to inform syphilis control strategies
Ashleigh R Tuite1, David N Fisman, Sharmistha Mishra
1Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
BMC Public Health
|June 27, 2013
Summary
Increasing syphilis screening frequency every three months is most effective for reducing infections in men who have sex with men (MSM). Higher frequency testing, even in smaller groups, surpasses broader coverage for controlling syphilis.
Area of Science:
- Public Health
- Epidemiology
- Mathematical Modeling
Background:
- Syphilis incidence is rising among men who have sex with men (MSM).
- Current screening and treatment efforts have not curbed the increase.
- This study investigates optimal screening strategies for syphilis control in MSM.
Purpose of the Study:
- To compare the impact of increased screening frequency versus increased screening coverage on syphilis incidence.
- To identify the most effective syphilis screening strategy for MSM in Toronto, Canada.
Main Methods:
- An agent-based network model simulating syphilis transmission among 2,000 high-risk MSM was developed.
- Model parameters were derived from regional surveillance data and literature.
- Evaluated strategies included annual screening, increased frequency, and increased coverage; impact measured over 10 years.
Main Results:
- Screening every three months was the most effective strategy for reducing syphilis incidence.
- Increased coverage without increased frequency yielded smaller reductions.
- Increased test frequency was more effective than improved coverage for an equivalent number of tests.
Conclusions:
- Higher frequency testing in smaller segments of the MSM population is more effective for reducing syphilis incidence.
- Treatment-induced loss of immunity can complicate screening-based control strategies.
- These findings offer insights for optimizing syphilis control programs targeting MSM.
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