Prioritizing Congenital Syphilis Control in South China: A Decision Analytic Model to Inform Policy Implementation

English version České info

Background:
Syphilis is a major public health problem in many regions of China, with increases in congenital syphilis (CS) cases causing concern. The Chinese Ministry of Health recently announced a comprehensive 10-y national syphilis control plan focusing on averting CS. The decision analytic model presented here quantifies the impact of the planned strategies to determine whether they are likely to meet the goals laid out in the control plan.

Methods and Findings:
Our model incorporated data on age-stratified fertility, female adult syphilis cases, and empirical syphilis transmission rates to estimate the number of CS cases associated with prenatal syphilis infection on a yearly basis. Guangdong Province was the focus of this analysis because of the availability of high-quality demographic and public health data. Each model outcome was simulated 1,000 times to incorporate uncertainty in model inputs. The model was validated using data from a CS intervention program among 477,656 women in China. Sensitivity analyses were performed to identify which variables are likely to be most influential in achieving Chinese and international policy goals. Increasing prenatal screening coverage was the single most effective strategy for reducing CS cases. An incremental increase in prenatal screening from the base case of 57% coverage to 95% coverage was associated with 106 (95% CI: 101, 111) CS cases averted per 100,000 live births (58% decrease). The policy strategies laid out in the national plan led to an outcome that fell short of the target, while a four-pronged comprehensive syphilis control strategy consisting of increased prenatal screening coverage, increased treatment completion, earlier prenatal screening, and improved syphilis test characteristics was associated with 157 (95% CI: 154, 160) CS cases averted per 100,000 live births (85% decrease).

Conclusions:
The Chinese national plan provides a strong foundation for syphilis control, but more comprehensive measures that include earlier and more extensive screening are necessary for reaching policy goals.

Please see later in the article for the Editors' Summary

Vyšlo v časopise: Prioritizing Congenital Syphilis Control in South China: A Decision Analytic Model to Inform Policy Implementation. PLoS Med 10(1): e32767. doi:10.1371/journal.pmed.1001375
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001375

Souhrn

Zdroje

1. TuckerJD, ChenXS, PeelingRW (2010) Syphilis and social upheaval in china. N Engl J Med 362: 1658–1661.

2. TemmermanM, GichangiP, FonckK, ApersL, ClaeysP, et al. (2000) Effect of a syphilis control programme on pregnancy outcome in Nairobi, Kenya. Sex Transm Infect 76: 117–121.

3. Watson-JonesD, ChangaluchaJ, GumodokaB, WeissH, RusizokaM, et al. (2002) Syphilis in pregnancy in tanzania. I. Impact of maternal syphilis on outcome of pregnancy. J Infect Dis 186: 940–947.

4. HawkesS, MatinN, BroutetN, LowN (2011) Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 11: 684–691.

5. TuckerJD, CohenMS (2011) China's syphilis epidemic: epidemiology, proximate determinants of spread, and control responses. Curr Opin Infect Dis 24: 50–55.

6. KambML, NewmanLM, RileyPL, MarkJ, HawkesSJ, et al. (2010) A road map for the global elimination of congenital syphilis. Obstet Gynecol Int 2010: 312798.

7. RydzakCE, GoldieSJ (2008) Cost-effectiveness of rapid point-of-care prenatal syphilis screening in sub-Saharan Africa. Sex Transm Dis 35: 775–784.

8. HongFC, LiuJB, FengTJ, LiuXL, PanP, et al. (2010) Congenital syphilis: an economic evaluation of a prevention program in China. Sex Transm Dis 37: 26–31.

9. WeinsteinMC, O'BrienB, HornbergerJ, JacksonJ, JohannessonM, et al. (2003) Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR task force on good research practices—modeling studies. Value Health 6: 9–17.

10. ChengJQ, ZhouH, HongFC, ZhangD, ZhangYJ, et al. (2007) Syphilis screening and intervention in 500,000 pregnant women in Shenzhen, the People's Republic of China. Sex Transm Infect 83: 347–350.

11. YangLG, TuckerJD, YangB, ShenSY, SunXF, et al. (2010) Primary syphilis cases in Guangdong Province 1995–2008: opportunities for linking syphilis control and regional development. BMC Public Health 10: 793.

12. WuZY, ZhouPY (2010) Syphilis and social upheaval in china. N Engl J Med 363: 1088–1089.

13. WuDD, HongFC, FengTJ, LiuXL, LinLJ, et al. (2010) Congenital syphilis: refining newborn evaluation and management in Shenzhen, southern China. Sex Transm Infect 86: 280–284.

14. HongFC, FengTJ, CaiYM, WenLZ, PanP, et al. (2009) Burden of syphilis infections in Shenzhen, China: a preliminary estimation. Int J STD AIDS 20: 115–118.

15. LarsenSA, SteinerBM, RudolphAH (1995) Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 8: 1–21.

16. ChapelTA (1980) The signs and symptoms of secondary syphilis. Sex Transm Dis 7: 161–164.

17. ChenZQ, ZhangGC, GongXD, LinC, GaoX, et al. (2007) Syphilis in China: results of a national surveillance programme. Lancet 369: 132–138.

18. DeperthesBD, MeheusA, O'ReillyK, BroutetN (2004) Maternal and congenital syphilis programmes: case studies in Bolivia, Kenya and South Africa. Bull World Health Organ 82: 410–416.

19. US Centers for Disease Control and Prevention (2010) 2010 STD treatment guidelines. Atlanta: US Centers for Disease Control and Prevention.

20. World Health Organization (2010) Elimination of congenital syphilis. Geneva: World Health Organization.

21. LinCC, GaoX, ChenXS, ChenQ, CohenMS (2006) China's syphilis epidemic: a systematic review of seroprevalence studies. Sex Transm Dis 33: 726–736.

22. MabeyDC, SollisKA, KellyHA, BenzakenAS, BitarakwateE, et al. (2012) Point-of-care tests to strengthen health systems and save newborn lives: the case of syphilis. PLoS Med 9: e1001233 doi:10.1371/journal.pmed.1001233.

23. TuckerJD, HawkesSJ, YinYP, PeelingRW, CohenMS, et al. (2010) Scaling up syphilis testing in China: implementation beyond the clinic. Bull World Health Organ 88: 452–457.

24. United Nations Statistics Division (2010) Antenatal care coverage (ANC) [database]. Available: http://data.un.org/Data.aspx?d=SOWC&f=inID%3A77. Accessed 1 July 2012.

25. CuiY, YangL, LuMT (2009) [Analysis on the status of antenatal checkup program in certain areas of China, 2005]. Zhonghua Liu Xing Bing Xue Za Zhi 30: 887–890.

26. LiCG, LiCF, LiQ, LiM (2009) Thalassemia incidence and treatment in China with special reference to Shenzhen City and Guangdong province. Hemoglobin 33: 296–303.

27. YanpingW, LeiM, LiD, ChunhuaH, XiaohongL, et al. (2010) A study on rural-urban differences in neonatal mortality rate in china, 1996–2006. J Epidemiol Community Health 64: 935–936.

28. TangJ, LiNX (2008) [Use of maternal health care services in poor regions in Sichuan.]. Sichuan Da Xue Xue Bao Yi Xue Ban 39: 1004–1006.

29. WendelGDJr, SheffieldJS, HollierLM, HillJB, RamseyPS, et al. (2002) Treatment of syphilis in pregnancy and prevention of congenital syphilis. Clin Infect Dis 35 (Suppl 2)

S200–S209.

30. LiuJB, HongFC, PanP, ZhouH, YangF, et al. (2010) A risk model for congenital syphilis in infants born to mothers with syphilis treated in gestation: a prospective cohort study. Sex Transm Infect 86: 292–296.

31. AlexanderJM, SheffieldJS, SanchezPJ, MayfieldJ, WendelGDJr (1999) Efficacy of treatment for syphilis in pregnancy. Obstet Gynecol 93: 5–8.

32. SheffieldJS, SanchezPJ, MorrisG, MaberryM, ZerayF, et al. (2002) Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obstet Gynecol 186: 569–573.

33. WalkerDG, WalkerGJ (2002) Forgotten but not gone: the continuing scourge of congenital syphilis. Lancet Infect Dis 2: 432–436.

34. HiraSK, BhatGJ, ChikamataDM, NkowaneB, TemboG, et al. (1990) Syphilis intervention in pregnancy: Zambian demonstration project. Genitourin Med 66: 159–164.

35. MunkhuuB, LiabsuetrakulT, ChongsuvivatwongV, McNeilE, JanchivR (2009) One-stop service for antenatal syphilis screening and prevention of congenital syphilis in Ulaanbaatar, Mongolia: a cluster randomized trial. Sex Transm Dis 36: 714–720.

36. ZhuL, QinM, DuL, XieRH, WongT, et al. (2010) Maternal and congenital syphilis in Shanghai, China, 2002 to 2006. Int J Infect Dis 14 (Suppl 3)

e45–e48.

37. World Health Organization (2007) The global elimination of congenital syphilis: rationale and strategy for action. Geneva: World Health Organization.

38. WilkinsonD, SachM (1998) Improved treatment of syphilis among pregnant women through on-site testing: an intervention study in rural South Africa. Trans R Soc Trop Med Hyg 92: 348.

39. FitzgeraldDW, BehetsF, PrevalJ, SchulwolfL, BommiV, et al. (2003) Decreased congenital syphilis incidence in Haiti's rural Artibonite region following decentralized prenatal screening. Am J Public Health 93: 444–446.

40. BronzanRN, Mwesigwa-KayongoDC, NarkunasD, SchmidGP, NeilsenGA, et al. (2007) On-site rapid antenatal syphilis screening with an immunochromatographic strip improves case detection and treatment in rural South African clinics. Sex Transm Dis 34 (Suppl 7)

S55–S60.

41. TuckerJD, YangLG, YangB, YoungD, HendersonGE, et al. (2011) Prior HIV testing among STD patients in Guangdong Province, China: opportunities for expanding detection of sexually transmitted HIV infection. Sex Transm Dis 39: 182–187.

42. SchmidG (2004) Economic and programmatic aspects of congenital syphilis prevention. Bull World Health Organ 82: 402–409.

43. BlandfordJM, GiftTL, VasaikarS, Mwesigwa-KayongoD, DlaliP, et al. (2007) Cost-effectiveness of on-site antenatal screening to prevent congenital syphilis in rural eastern Cape Province, Republic of South Africa. Sex Transm Dis 34 (Suppl 7)

S61–S66.

44. SchackmanBR, NeukermansCP, FontainSN, NolteC, JosephP, et al. (2007) Cost-effectiveness of rapid syphilis screening in prenatal HIV testing programs in Haiti. PLoS Med 4: e183 doi:10.1371/journal.pmed.0040183.

45. VickermanP, PeelingRW, Terris-PrestholtF, ChangaluchaJ, MabeyD, et al. (2006) Modelling the cost-effectiveness of introducing rapid syphilis tests into an antenatal syphilis screening programme in Mwanza, Tanzania. Sex Transm Infect 82 (Suppl 5)v38–v43.

46. United Nations (2011) What they are [Millennium Development Goals]. Available: http://www.unmillenniumproject.org/goals/index.htm. Accessed 1 July 2012.

47. Asian Development Bank (2012) Health. Available: http://www.adb.org/sectors/health/main. Accessed 1 July 2012.

48. ParishWL, LaumannEO, CohenMS, PanS, ZhengH, et al. (2003) Population-based study of chlamydial infection in China: a hidden epidemic. JAMA 289: 1265–1273.

49. ZhaoF, GuoSF, LiBH, CuiY, WuKS (2005) [Survey on the situation of antenatal care in different regions of China in 1971–2003]. Zhonghua Liu Xing Bing Xue Za Zhi 26: 172–176.

50. JiaoT, XuX, HanCY, LiuL, ZhouY, et al. (2010) [Perinatal outcomes of pregnant women with syphilis treated by procaine penicillin at different gestations]. Chin J Derm Venereol 24: 934.

51. ZhangXM, ZhangRN, LinSQ, ChenSX, ZhengLY (2004) [Clinical analysis of 192 pregnant women infected by syphilis.]. Zhonghua Fu Chan Ke Za Zhi 39: 682–686.

52. LiL, LiuM, WangF (2009) [Clinical analysis on 121 pregnant women infected by syphilis.]. Matern Child Health Care China 24: 4087.

53. China National STD Control Center (2010) [2010 national STD control and prevention national treatment guidelines]. Nanjing: China National STD Control Center.