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Epidemiology oral session 9: Use of observational data and mathematical modelling for impact evaluation
O1-S09.04 Modelled impact of changing participation rates on effectiveness of population based chlamydia screening
  1. B V Schmid1,
  2. I V F van den Broek2,
  3. E L M Op de Coul2,
  4. J E A M van Bergen3,
  5. J S A Fennema4,
  6. H M Götz5,
  7. C J P A Hoebe6,
  8. M Kretzschmar7
  1. 1National Institute for Public Health and the Environment RIVM, Bilthoven, Netherlands
  2. 2National Institute for Public Health and the Environment, Bilthoven, Netherlands
  3. 3STI AIDS Netherlands, Amsterdam, Netherlands
  4. 4Amsterdam Public Health Service, Amsterdam, Netherlands
  5. 5Rotterdam Rijnmond Public Health Service, Rotterdam, Netherlands
  6. 6South Limburg Public Health Service, Geleen, Netherlands
  7. 7National Institute for Public Health and the Environment, University Medical Centre, Utrecht, Netherlands

Abstract

Background The Chlamydia Screening Implementation (CSI) is a Dutch large-scale pilot of an internet-based self-sampling Chlamydia trachomatis (Ct) screening program for 16–29-year-old men and women. The effectiveness of CSI can be estimated from changes in the positivity rate of the sampled individuals, but shifts in health-care use and CSI participation rates makes modelling a valuable alternative approach for estimating screening effectiveness.

Methods We simulated the spread of Ct in a heterosexual population of age 13–65, using sexual survey data to parametrise a dynamic sexual contact network. A screening program was implemented in the model by constructing “participation trees”, which capture the likelihood to participate given an individuals participation history, as observed in the CSI program. Currently available health-care options to test for and treat Ct were also implemented in the model as a baseline (including trends in their usage), against which the effect of screening could be compared. In order to estimate the long-term effects of screening on the Ct prevalence in the Netherlands, future participation rates were estimated from trends in the yearly number of new participants, and by extrapolation of the participation trees.

Results Compared to a baseline scenario, there is a moderate additional effect of 3 years of screening: the estimated Ct prevalence for the target population (16–29) dropped from 2.8% to 1.7% in large cities, and from 1.9% to 1.2% in more rural regions. As repeated invitees were likely not to participate, the largest effect of screening occurred in its first year when everyone in the target population was invited for the first time. After 3 years, the largest effect of screening on the Ct prevalence had been reached. Due to the anticipated further decrease in participation rates the long-term decrease in Ct prevalence is estimated to be in the range of 0.5–0.7 and 0.4–0.6 per cent-points in urban and rural regions, respectively.

Conclusions A continued population based screening program has a permanent additional effect on lowering the Ct prevalence in the Netherlands, but the size of this effect is strongly tied to the participation rate in the targeted population. Therefore, the accuracy of long-term predictions of screening effectiveness depends on a good model implementation of the available data on participation behaviour.

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