Optimizing strategies for population-based chlamydia infection screening among young women: an age-structured system dynamics approach

BMC Public Health

Research Article

Wanzhu Tu¹  Yu Teng²  Nan Kong³ 

[1] Department of Biostatistics, Indiana University School of Medicine, 410 West 10th St, Suite 3000, 46202, Indianapolis, Indiana, USA;Futures Institute, 41-A New London Tpke, 06033, Glastonbury, Connecticut, USA;Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr, 47907, West Lafayette, Indiana, USA;

关键词: Age-structured system dynamics;    Infectious disease modeling;    Disease screening;    Parameter optimization;   

DOI  :  10.1186/s12889-015-1975-z

 received in 2014-12-29, accepted in 2015-06-25,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundChlamydia infection (CT) is one of the most commonly reported sexually transmitted diseases. It is often referred to as a “silent” disease with the majority of infected people having no symptoms. Without early detection, it can progress to serious reproductive and other health problems. Economical identification of asymptomatically infected is a key public health challenge. Increasing evidence suggests that CT infection risk varies over the range of adolescence. Hence, age-dependent screening strategies with more frequent testing for certain age groups of higher risk may be cost-saving in controlling the disease.MethodsWe study the optimization of age-dependent screening strategies for population-based chlamydia infection screening among young women. We develop an age-structured compartment model for CT natural progress, screening, and treatment. We apply parameter optimization on the resultant PDE-based system dynamical models with the objective of minimizing the total care spending, including screening and treatment costs during the program period and anticipated costs of treating the sequelae afterwards). For ease of practical implementation, we also search for the best screening initiation age for strategies with a constant screening frequency.ResultsThe optimal age-dependent strategies identified outperform the current CDC recommendations both in terms of total care spending and disease prevalence at the termination of the program. For example, the age-dependent strategy that allows monthly screening rate changes can save about 5 % of the total spending. Our results suggest early initiation of CT screening is likely beneficial to the cost saving and prevalence reduction. Finally, our results imply that the strategy design may not be sensitive to accurate quantification of the age-specific CT infection risk if screening initiation age and screening rate are the only decisions to make.ConclusionsOur research demonstrates the potential economic benefit of age-dependent screening strategy design for population-based screening programs. It also showcases the applicability of age-structured system dynamical modeling to infectious disease control with increasing evidence on the age differences in infection risk. The research can be further improved with consideration of the difference between first-time infection and reinfection, as well as population heterogeneity in sexual partnership.

【 授权许可】

Unknown   
© Teng et al. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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