NEEMA Funded Projects by Topic Area – STD
NEEMA 2.0 (2019-2024)
Identifying geographic areas of populations at risk for higher and worsening rates of STDs or poor health outcomes from these infections can help to prioritize resource allocations and prevention efforts. Drawing on similar work in evaluating county-level vulnerability to HIV and hepatitis C outbreaks and on more recent work on vulnerability to outbreaks of congenital syphilis, this project will use multilevel regression modeling to identify indicators predictive of (i) gonorrhea cases that are most likely to be antibiotic-resistant and (ii) jurisdictions that have increased vulnerability to STD increases and outbreaks.
The COVID-19 pandemic has disrupted public health surveillance in general, and sentinel surveillance for antimicrobial resistant gonorrhea (ARGC) in particular, as well as non-life-threatening health care delivery. Fewer isolates are available at ARGC sentinel surveillance sites due to the reduction of STD clinic services in some sites. More broadly, healthcare seeking has been impacted in most parts of the country, limiting the opportunity for patients to be screened or receive diagnostic testing for STDs. In particular, the reduction in screening and treatment (and the shift from injectable to oral treatment for gonorrhea in response to clinic closures) may increase the incidence and prevalence of ARGC. People likely have also shifted their behaviors in ways that may either reduce or increase transmission. This project will estimate the potential collective effects of these scenarios on the incidence and prevalence of ARGC. This work builds on the previously developed compartmental model of gonorrhea transmission among men who have sex with men (MSM), adapted to account for changes in behaviors that affect transmission, service availability, health-seeking behaviors, and screening and treatment practices.
The U.S. Preventive Services Task Force recommends annual screening for chlamydia in sexually active women under age 25 is recommended by the U.S. Preventive Services Task Force. Evidence suggests that chlamydia screening may be protective against pelvic inflammatory disease (PID). PID can lead to more severe health outcomes, like tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In men, chlamydia can cause urethritis and epididymitis. Previous studies suggest that chlamydia screening can be cost-effective; however, no transmission model has assessed cost-effectiveness of chlamydia screening in the United States at the 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 during 2000-2015 and assess the cost-effectiveness of chlamydia screening.
Sexually transmitted infections (STIs) can increase the risk of getting or transmitting HIV. A previous study found that overall, an estimated 10% of HIV infections were attributable to gonorrhea and chlamydia infection. This project builds on the previous study to estimate the probability of gonorrhea or chlamydia infection leading to an HIV infection. This project also aims to estimate the cost-effectiveness of gonorrhea and chlamydia screening programs on reducing HIV incidence among MSM in the United States.
Estimates of the quality-of-life impacts of STIs are needed to quantify the health burden of STIs and to inform cost-effectiveness analyses of STI 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 STI 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 a gonorrhea analysis initiated in NEEMA 1.0 to compute QALYs lost for chlamydia and trichomoniasis. A Markov modeling approach and evidence synthesis will be used to compute QALYs lost for syphilis and HSV-2.
Estimating the size of sexually active adult and adolescent populations at a sub-national level (e.g., county) would improve the local understanding of disease burden of STIs. These estimates would also facilitate comparisons of disease rates, such as HIV and syphilis, between MSM and other populations. Building on the methods used to estimate the size of the MSM population, 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, overall and by race and ethnicity. These estimates can then be used to generate estimates of disease rates for each of these population groups.