Dataset Information

The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities - a mathematical modeling study.

ABSTRACT:

Background

Canadian Arctic communities have experienced sustained syphilis transmission, with diagnoses rates 18-times higher than the national average. Remoteness from laboratory facilities leads to delays between syphilis screening and treatment, contributing to onward transmission. Rapid diagnostic tests can eliminate treatment delays via testing at the point-of-care. This study aims to describe syphilis diagnostic gaps and to estimate the impact of introducing rapid diagnostic tests at the point-of-care on syphilis transmission.

Methods

To assess the population-level impact of deploying rapid diagnostic tests, an individual-based model was developed using detailed surveillance data, population surveys, and a prospective diagnostic accuracy field study. The model was calibrated to syphilis diagnoses (2017-2022) from a community of approximately 1,050 sexually active individuals. The impacts of implementing rapid diagnostic tests using whole blood (sensitivity: 92% for infectious and 81% for non-infectious syphilis; specificity: 99%) from 2023 onward was calculated using the annual median fraction of cumulative new syphilis infections averted over 2023-2032.

Findings

The median modeled syphilis incidence among sexually active individuals was 44 per 1,000 in 2023. Males aged 16-30 years exhibited a 51% lower testing rate than that of their female counterparts. Maintaining all interventions constant at their 2022 levels, implementing rapid diagnostic tests could avert a cumulative 33% (90% credible intervals: 18-43%) and 37% (21-46%) of new syphilis infections over 5 and 10 years, respectively. Increasing testing rates and contact tracing may enhance the effect of rapid diagnostic tests.

Interpretation

Implementing rapid diagnostic tests for syphilis in Arctic communities could reduce infections and enhance control of epidemics. Such effective diagnostic tools could enable rapid outbreak responses by providing same-day testing and treatment at the point-of-care.

Funding

Canadian Institutes of Health Research.

SUBMITTER: Xia Y

PROVIDER: S-EPMC11295708 | biostudies-literature | 2024 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities - a mathematical modeling study.

Xia Yiqing Y Caya Chelsea C Morin Véronique V Singh Ameeta E AE Serhir Bouchra B Libman Michael M Goldfarb David M DM Wong Tom T Xiu Fanyu F Bélanger Richard R Touchette Jean-Sébastien JS Yansouni Cédric P CP Maheu-Giroux Mathieu M

Lancet regional health. Americas 20240720

<h4>Background</h4>Canadian Arctic communities have experienced sustained syphilis transmission, with diagnoses rates 18-times higher than the national average. Remoteness from laboratory facilities leads to delays between syphilis screening and treatment, contributing to onward transmission. Rapid diagnostic tests can eliminate treatment delays via testing at the point-of-care. This study aims to describe syphilis diagnostic gaps and to estimate the impact of introducing rapid diagnostic tests ...[more]

PMID: 39100242

Similar Datasets

Project description:BackgroundIntense transmission of syphilis has emerged in some Canadian Arctic communities despite screening and prevention efforts. The remoteness of most communities and limited diagnostic infrastructure yield long delays (≥14 days) between screening and treatment of cases. These hamper syphilis control efforts and may contribute to sustained transmission. Syphilis rapid diagnostic tests (RDTs) have been developed to make screening more accessible and to inform clinical decision-making within the same clinical encounter. These RDTs have been successfully deployed in several countries, but not yet in Canada.Methods and designWe describe the methodology of the "Stopping Syphilis Transmission in Arctic Communities Through Rapid Diagnostic Testing" (STAR) study, wherein the clinical and epidemiological impact of deploying a dual syphilis RDT in the context of ongoing transmission in Nunavut and Nunavik will be evaluated. In this prospective multisite field evaluation, sexually active individuals aged ≥14 years at risk for syphilis will be offered screening by an RDT at the point-of-care by non-laboratory trained registered nurses. Whole blood and serum specimens will be concurrently collected, when feasible, for rapid testing with an RDT containing both treponemal and non-treponemal components (Chembio DPP® Syphilis Screen & Confirm) and compared to laboratory-based reference testing according to a reverse sequence algorithm. The diagnostic accuracy of the RDT, using both whole blood and centrifuged serum specimens, will be validated under real-world conditions in remote Northern settings, outside of specialized laboratories. Additionally, screening-to-treatment time, case detection rates, and the number of infectious contacts averted by using the RDT relative to reference testing will be estimated. The impact of both diagnostic approaches on syphilis transmission dynamics will also be modeled.DiscussionThis study will provide much needed evidence for strengthening rapid responses to emerging syphilis outbreaks in remote Arctic regions, by supplementing traditional diagnostic strategies with an RDT to rapidly triage patients likely in need of treatment. These results will also inform the development and tailoring of future diagnostic strategies and public health responses to emerging outbreaks in the North.

Project description:A sulfur-dominated supraglacial spring system found at Borup Fiord Pass (BFP), Ellesmere Island, Nunavut, Canada, is a unique sulfur-on-ice system expressed along the toe of a glacier. BFP has an intermittent flowing, subsurface-derived, glacial spring that creates a large white-yellow icing (aufeis) that extends down-valley. Over field campaigns in 2014, 2016, and 2017, numerous samples were collected and analyzed for both microbial community composition and aqueous geochemistry. Samples were collected from multiple site types: spring discharge fluid, aufeis (spring-derived ice), melt pools with sedimented cryoconite material, and mineral precipitate scrapings, to probe how microbial communities differed between site types in a dynamic freeze/thaw sulfur-rich system. Dissolved sulfate varied between 0.07 and 11.6 mM and was correlated with chloride concentrations, where the fluids were saltiest among spring fluids. The highest sulfate samples exhibited high dissolved sulfide values between 0.22 and 2.25 mM. 16S rRNA gene sequencing from melt pool and aufeis samples from the 2014 campaign were highly abundant in operational taxonomic units (OTUs) closely related to sulfur-oxidizing microorganisms (SOM; Sulfurimonas, Sulfurovum, and Sulfuricurvum). Subsequent sampling 2 weeks later had fewer SOMs and showed an increased abundance of the genus Flavobacterium. Desulfocapsa, an organism that specializes in the disproportionation of inorganic sulfur compounds was also found. Samples from 2016 and 2017 revealed that microorganisms present were highly similar in community composition to 2014 samples, primarily echoed by the continued presence of Flavobacterium sp. Results suggest that while there may be acute events where sulfur cycling organisms dominate, a basal community structure appears to dominate over time and site type. These results further enhance our knowledge of low-temperature sulfur systems on Earth, and help to guide the search for potential life on extraterrestrial worlds, such as Europa, where similar low-temperature sulfur-rich conditions may exist.

Project description:Functional magnetic resonance imaging (fMRI) measures brain activity by detecting the blood-oxygen-level dependent (BOLD) response to neural activity. The BOLD response depends on the neurovascular coupling, which connects cerebral blood flow, cerebral blood volume, and deoxyhemoglobin level to neuronal activity. The exact mechanisms behind this neurovascular coupling are not yet fully investigated. There are at least three different ways in which these mechanisms are being discussed. Firstly, mathematical models involving the so-called Balloon model describes the relation between oxygen metabolism, cerebral blood volume, and cerebral blood flow. However, the Balloon model does not describe cellular and biochemical mechanisms. Secondly, the metabolic feedback hypothesis, which is based on experimental findings on metabolism associated with brain activation, and thirdly, the neurotransmitter feed-forward hypothesis which describes intracellular pathways leading to vasoactive substance release. Both the metabolic feedback and the neurotransmitter feed-forward hypotheses have been extensively studied, but only experimentally. These two hypotheses have never been implemented as mathematical models. Here we investigate these two hypotheses by mechanistic mathematical modeling using a systems biology approach; these methods have been used in biological research for many years but never been applied to the BOLD response in fMRI. In the current work, model structures describing the metabolic feedback and the neurotransmitter feed-forward hypotheses were applied to measured BOLD responses in the visual cortex of 12 healthy volunteers. Evaluating each hypothesis separately shows that neither hypothesis alone can describe the data in a biologically plausible way. However, by adding metabolism to the neurotransmitter feed-forward model structure, we obtained a new model structure which is able to fit the estimation data and successfully predict new, independent validation data. These results open the door to a new type of fMRI analysis that more accurately reflects the true neuronal activity.

Dataset Information

The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities - a mathematical modeling study.

Background

Methods

Findings

Interpretation

Funding

Publications

The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities - a mathematical modeling study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets