Per-partnership transmission probabilities for Chlamydia trachomatis infection: evidence synthesis of population-based survey data

Author:

Lewis Joanna12,White Peter J13,Price Malcolm J45

Affiliation:

1. MRC Centre for Global Infectious Disease Analysis and National Institute for Health Research (NIHR) Health Protection Research Unit in Modelling and Health Economics, Imperial College London School of Public Health, London, UK

2. Centre for Applied Statistics Courses, UCL Great Ormond Street Institute of Child Health, University College London, London, UK

3. Modelling and Economics Unit, National Infection Service, Public Health England, London, UK

4. Institute of Applied Health Research, University of Birmingham, Birmingham, UK

5. NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK

Abstract

Abstract Background Chlamydia is the most commonly diagnosed sexually transmitted infection worldwide. Mathematical models used to plan and assess control measures rely on accurate estimates of chlamydia’s natural history, including the probability of transmission within a partnership. Several methods for estimating transmission probability have been proposed, but all have limitations. Methods We have developed a new model for estimating per-partnership chlamydia transmission probabilities from infected to uninfected individuals, using data from population-based surveys. We used data on sexual behaviour and prevalent chlamydia infection from the second UK National Study of Sexual Attitudes and Lifestyles (Natsal-2) and the US National Health and Nutrition Examination Surveys 2009–2014 (NHANES) for Bayesian inference of average transmission probabilities, across all new heterosexual partnerships reported. Posterior distributions were estimated by Markov chain Monte Carlo sampling using the Stan software. Results Posterior median male-to-female transmission probabilities per partnership were 32.1% [95% credible interval (CrI) 18.4–55.9%] (Natsal-2) and 34.9% (95%CrI 22.6–54.9%) (NHANES). Female-to-male transmission probabilities were 21.4% (95%CrI 5.1–67.0%) (Natsal-2) and 4.6% (95%CrI 1.0–13.1%) (NHANES). Posterior predictive checks indicated a well-specified model, although there was some discrepancy between reported and predicted numbers of partners, especially in women. Conclusions The model provides statistically rigorous estimates of per-partnership transmission probability, with associated uncertainty, which is crucial for modelling and understanding chlamydia epidemiology and control. Our estimates incorporate data from several sources, including population-based surveys, and use information contained in the correlation between number of partners and the probability of chlamydia infection. The evidence synthesis approach means that it is easy to include further data as it becomes available.

Funder

National Institute for Health Research

Health Protection Research Unit

Public Health England

NIHR

Imperial College London and LSHTM

MRC Centre for Global Infectious Disease Analysis

UK Medical Research Council

UK Foreign, Commonwealth & Development Office

MRC

FCDO

European Union

NIHR Birmingham Biomedical Research Centre

University Hospitals Birmingham NHS Foundation Trust

University of Birmingham

Publisher

Oxford University Press (OUP)

Subject

General Medicine,Epidemiology

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