NEEMA Funded Projects by Topic Area - STD
NEEMA 2.0 (2019-2024)
Annual screening for chlamydia in sexually-active women under age 25 is recommended by the US Preventive Services Task Force. Evidence suggests that chlamydia screening may be protective against pelvic inflammatory disease. Pelvic inflammatory disease can lead to more severe health outcomes, namely tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In men, chlamydia can cause urethritis and epididymitis. There is an existing body of work suggesting that chlamydia screening can be cost-effective. However, no transmission model has assessed cost-effectiveness of chlamydia screening in the United States taking into account the prevention levels that have been achieved up to the present. This project will use a calibrated chlamydia transmission model to estimate the number of sequelae averted and quality-adjusted life years gained by chlamydia screening for 2000-2015 and assess the cost-effectiveness of chlamydia screening.
Sexually transmitted infections are associated with an increased risk of HIV acquisition and transmission. A previous study found that overall, 10.2% of HIV infections were attributable to gonorrhea and chlamydia infection. This project will build on the previous work to estimate the cost-effectiveness of gonorrhea and chlamydia screening programs on reducing HIV incidence among men who have sex with men (MSM) in the United States. This project will also work to estimate the probability that a gonorrhea and chlamydia infection will lead to an HIV infection.
Estimates of the quality of life impacts of STDs are needed to quantify the health burden of STDs and to inform cost-effectiveness analyses of STD prevention interventions. Use of quality-adjusted life years (QALYs) enables comparison across a wide range of conditions and outcomes. The purpose of this project is to develop estimates of the expected lifetime number of QALYs lost per infection for six major STIs: chlamydia, gonorrhea, syphilis, herpes simplex virus type 2 (HSV-2) and trichomoniasis. In addition to informing cost-effectiveness analyses of STD prevention interventions, this project’s results, when combined with estimates of STI incidence, will provide estimates of the overall population health burden of each STI. This project will build on the previously developed probability tree model, formal evidence synthesis, and literature review to estimate and value downstream consequences of infection across different racial/ethnic groups in the US. This project will update gonorrhea analysis to compute QALYs for chlamydia and trichomoniasis, and to use a Markov modeling approach and evidence synthesis to compute QALYs for syphilis and HSV-2.
Estimating the sexually active adult and adolescent population at a sub-national level (e.g., county) would improve the local understanding of disease burden of STIs. These estimates would also facilitate relative comparisons of syphilis and HIV burden between MSM and other populations. This project will develop state and county-level estimates for the population of men who have sex with women (exclusively), women who have sex with men, and sexually-active adolescent sexual minority males (ASMM), overall and by race/ethnicity. These estimates can then be used to generate estimates of disease rates in the relevant populations.