Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia

The ability to treat gonorrhoea with current first-line drugs is threatened by the global spread of extensively drug resistant (XDR) Neisseria gonorrhoeae (NG) strains. In Australia, urban transmission is high among men who have sex with men (MSM) and importation of an XDR NG strain in this populati...

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Autores principales:	Qibin Duan, Chris Carmody, Basil Donovan, Rebecca J. Guy, Ben B. Hui, John M. Kaldor, Monica M. Lahra, Matthew G. Law, David A. Lewis, Michael Maley, Skye McGregor, Anna McNulty, Christine Selvey, David J. Templeton, David M. Whiley, David G. Regan, James G. Wood
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/bc974e0ca3c0485ab544b58ec1f690fd
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spelling	oai:doaj.org-article:bc974e0ca3c0485ab544b58ec1f690fd2021-11-25T05:41:10ZModelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia1553-734X1553-7358https://doaj.org/article/bc974e0ca3c0485ab544b58ec1f690fd2021-11-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594806/?tool=EBIhttps://doaj.org/toc/1553-734Xhttps://doaj.org/toc/1553-7358The ability to treat gonorrhoea with current first-line drugs is threatened by the global spread of extensively drug resistant (XDR) Neisseria gonorrhoeae (NG) strains. In Australia, urban transmission is high among men who have sex with men (MSM) and importation of an XDR NG strain in this population could result in an epidemic that would be difficult and costly to control. An individual-based, anatomical site-specific mathematical model of NG transmission among Australian MSM was developed and used to evaluate the potential for elimination of an imported NG strain under a range of case-based and population-based test-and-treat strategies. When initiated upon detection of the imported strain, these strategies enhance the probability of elimination and reduce the outbreak size compared with current practice (current testing levels and no contact tracing). The most effective strategies combine testing targeted at regular and casual partners with increased rates of population testing. However, even with the most effective strategies, outbreaks can persist for up to 2 years post-detection. Our simulations suggest that local elimination of imported NG strains can be achieved with high probability using combined case-based and population-based test-and-treat strategies. These strategies may be an effective means of preserving current treatments in the event of wider XDR NG emergence. Author summary In most high-income settings, gonorrhoea is endemic among men who have sex with men (MSM). While gonorrhoea remains readily treatable with antibiotics, there are major concerns about the threat of antimicrobial resistance arising from recent reports of treatment failure with first-line therapy and limited remaining treatment options. Here we investigated the potential for test-and-treat response strategies to eliminate such strains before their prevalence reaches a level requiring a shift to new first line therapies. Rather than directly consider resistance, we explore the mitigating effect of various test-and-treat measures on outbreaks of a generic imported strain which remains treatable. This is done within the framework of a realistic mathematical model of gonorrhoea spread in an MSM community that captures cases, anatomical sites of infection and sexual contacts at an individual level, calibrated to relevant Australian epidemiological data. The results indicate that strategies such as partner testing and treatment in combination with elevated asymptomatic community testing are highly effective in mitigating outbreaks but can take up to 2 years to achieve elimination. As there are currently no clear alternative drugs of proven efficacy and safety to replace ceftriaxone in first-line therapy, these promising results suggest potential for use of these outbreak response strategies to preserve current treatment recommendations.Qibin DuanChris CarmodyBasil DonovanRebecca J. GuyBen B. HuiJohn M. KaldorMonica M. LahraMatthew G. LawDavid A. LewisMichael MaleySkye McGregorAnna McNultyChristine SelveyDavid J. TempletonDavid M. WhileyDavid G. ReganJames G. WoodPublic Library of Science (PLoS)articleBiology (General)QH301-705.5ENPLoS Computational Biology, Vol 17, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Biology (General) QH301-705.5
spellingShingle	Biology (General) QH301-705.5 Qibin Duan Chris Carmody Basil Donovan Rebecca J. Guy Ben B. Hui John M. Kaldor Monica M. Lahra Matthew G. Law David A. Lewis Michael Maley Skye McGregor Anna McNulty Christine Selvey David J. Templeton David M. Whiley David G. Regan James G. Wood Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia
description	The ability to treat gonorrhoea with current first-line drugs is threatened by the global spread of extensively drug resistant (XDR) Neisseria gonorrhoeae (NG) strains. In Australia, urban transmission is high among men who have sex with men (MSM) and importation of an XDR NG strain in this population could result in an epidemic that would be difficult and costly to control. An individual-based, anatomical site-specific mathematical model of NG transmission among Australian MSM was developed and used to evaluate the potential for elimination of an imported NG strain under a range of case-based and population-based test-and-treat strategies. When initiated upon detection of the imported strain, these strategies enhance the probability of elimination and reduce the outbreak size compared with current practice (current testing levels and no contact tracing). The most effective strategies combine testing targeted at regular and casual partners with increased rates of population testing. However, even with the most effective strategies, outbreaks can persist for up to 2 years post-detection. Our simulations suggest that local elimination of imported NG strains can be achieved with high probability using combined case-based and population-based test-and-treat strategies. These strategies may be an effective means of preserving current treatments in the event of wider XDR NG emergence. Author summary In most high-income settings, gonorrhoea is endemic among men who have sex with men (MSM). While gonorrhoea remains readily treatable with antibiotics, there are major concerns about the threat of antimicrobial resistance arising from recent reports of treatment failure with first-line therapy and limited remaining treatment options. Here we investigated the potential for test-and-treat response strategies to eliminate such strains before their prevalence reaches a level requiring a shift to new first line therapies. Rather than directly consider resistance, we explore the mitigating effect of various test-and-treat measures on outbreaks of a generic imported strain which remains treatable. This is done within the framework of a realistic mathematical model of gonorrhoea spread in an MSM community that captures cases, anatomical sites of infection and sexual contacts at an individual level, calibrated to relevant Australian epidemiological data. The results indicate that strategies such as partner testing and treatment in combination with elevated asymptomatic community testing are highly effective in mitigating outbreaks but can take up to 2 years to achieve elimination. As there are currently no clear alternative drugs of proven efficacy and safety to replace ceftriaxone in first-line therapy, these promising results suggest potential for use of these outbreak response strategies to preserve current treatment recommendations.
format	article
author	Qibin Duan Chris Carmody Basil Donovan Rebecca J. Guy Ben B. Hui John M. Kaldor Monica M. Lahra Matthew G. Law David A. Lewis Michael Maley Skye McGregor Anna McNulty Christine Selvey David J. Templeton David M. Whiley David G. Regan James G. Wood
author_facet	Qibin Duan Chris Carmody Basil Donovan Rebecca J. Guy Ben B. Hui John M. Kaldor Monica M. Lahra Matthew G. Law David A. Lewis Michael Maley Skye McGregor Anna McNulty Christine Selvey David J. Templeton David M. Whiley David G. Regan James G. Wood
author_sort	Qibin Duan
title	Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia
title_short	Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia
title_full	Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia
title_fullStr	Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia
title_full_unstemmed	Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia
title_sort	modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in australia
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/bc974e0ca3c0485ab544b58ec1f690fd
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Modelling response strategies for controlling gonorrhoea outbreaks in men who have sex with men in Australia

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