Introduction:Mongolia's health ministry prioritizes control of Sexually Transmitted Infections,including syphilis screening and treatment in antenatal care(ANC).Methods:Adult syphilis prevalence trends were fitted...Introduction:Mongolia's health ministry prioritizes control of Sexually Transmitted Infections,including syphilis screening and treatment in antenatal care(ANC).Methods:Adult syphilis prevalence trends were fitted using the Spectrum-STI estimation tool,using data from ANC surveys and routine screening over 1997e2016.Estimates were combined with programmatic data to estimate numbers of treated and untreated pregnant women with syphilis and associated incidence congenital syphilis(CS)and CS-attributable adverse birth outcomes(ABO),which we compared with CS case reports.Results:Syphilis prevalence in pregnant women was estimated at 1.7%in 2000 and 3.0%in 2016.We estimated 652 CS cases,of which 410 ABO,in 2016.Far larger,annually increasing numbers of CS cases and ABO were estimated to have been prevented:1654 cases,of which 789 ABO in 2016thanks to increasing coverages of ANC(99%in 2016),ANC-based screening(97%in 2016)and treatment of women diagnosed(81%in 2016).The 42 CS cases reported nationally over 2016(liveborn infants only)represented 27%of liveborn infants with clinical CS,but only 7%of estimated CS cases among women found syphilis-infected in ANC,and 6%of all estimated CS cases including those born to women with undiagnosed syphilis.Discussion/Conclusion:Mongolia's ANC-based syphilis screening program is reducing CS,but maternal prevalence remains high.To eliminate CS(target:<50 cases per 100,000 live births),Mongolia should strengthen ANC services,limiting losses during referral for treatment,and under-diagnosis of CS including still-births and neonatal deaths,and expand syphilis screening and prevention programs.展开更多
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 u...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.展开更多
基金funded by the World Health Organization,Department of Reproductive Health and Research
文摘Introduction:Mongolia's health ministry prioritizes control of Sexually Transmitted Infections,including syphilis screening and treatment in antenatal care(ANC).Methods:Adult syphilis prevalence trends were fitted using the Spectrum-STI estimation tool,using data from ANC surveys and routine screening over 1997e2016.Estimates were combined with programmatic data to estimate numbers of treated and untreated pregnant women with syphilis and associated incidence congenital syphilis(CS)and CS-attributable adverse birth outcomes(ABO),which we compared with CS case reports.Results:Syphilis prevalence in pregnant women was estimated at 1.7%in 2000 and 3.0%in 2016.We estimated 652 CS cases,of which 410 ABO,in 2016.Far larger,annually increasing numbers of CS cases and ABO were estimated to have been prevented:1654 cases,of which 789 ABO in 2016thanks to increasing coverages of ANC(99%in 2016),ANC-based screening(97%in 2016)and treatment of women diagnosed(81%in 2016).The 42 CS cases reported nationally over 2016(liveborn infants only)represented 27%of liveborn infants with clinical CS,but only 7%of estimated CS cases among women found syphilis-infected in ANC,and 6%of all estimated CS cases including those born to women with undiagnosed syphilis.Discussion/Conclusion:Mongolia's ANC-based syphilis screening program is reducing CS,but maternal prevalence remains high.To eliminate CS(target:<50 cases per 100,000 live births),Mongolia should strengthen ANC services,limiting losses during referral for treatment,and under-diagnosis of CS including still-births and neonatal deaths,and expand syphilis screening and prevention programs.
基金Financial support for this work was provided by the World Health Organization(WHO)PNG Country Office.
文摘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.
