Agent-based modelling study of antimicrobial-resistant Neisseria gonorrhoeae transmission in men who have sex with men

Towards individualised diagnosis and treatment

Adam K. Zienkiewicz, Nicolás Verschueren Van Rees, Martin Homer, Jason J. Ong, Hannah Christensen, Darryl Hill, Katharine J. Looker, Paddy Horner, Gwenda Hughes, Katy M.E. Turner

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Background: Antimicrobial-resistant (AMR) gonorrhoea is a global public health threat. Discriminatory point-of-care tests (POCT) to detect drug sensitivity are under development, enabling individualised resistance-guided therapy. Methods: An individual-based dynamic transmission model of gonorrhoea infection in MSM living in London has been developed, incorporating ciprofloxacin-sensitive and resistant strains. The time-dependent sexual contact network is captured by periodically restructuring active connections to reflect the transience of contacts. Different strategies to improve treatment selection were explored, including discriminatory POCT and selecting partner treatment based on either the index case or partner susceptibility. Outcomes included population prevalence of gonorrhoea and drug dose counts. Results: It is shown that using POCT to detect ciprofloxacin-sensitive infections could result in a large decrease in ceftriaxone doses (by 70% compared with the reference case in the simulations of this study). It also suggests that ceftriaxone use can be reduced with existing technologies, albeit to a lesser degree either using index case sensitivity profiles to direct treatment of partners, or testing notified partners with strain discriminatory laboratory tests before treatment, reduced ceftriaxone use in our model (by 27% and 47% respectively). Conclusions: POCT to detect ciprofloxacin-sensitive gonorrhoea are likely to dramatically reduce reliance on ceftriaxone, but requires the implementation of new technology. In the meantime, the proportion of unnecessary ceftriaxone treatment by testing partners before treatment could be reduced significantly. Alternatively, index case sensitivity profiles could be used to select effective treatments for partners.

Original languageEnglish
Pages (from-to)514-522
Number of pages9
JournalSexual Health
Volume16
Issue number5
DOIs
Publication statusPublished - 3 Sep 2019

Keywords

  • antimicrobial resistance
  • diagnostics
  • gonorrhoea
  • point-of-care test
  • resistance-guided therapy

Cite this

Zienkiewicz, Adam K. ; Verschueren Van Rees, Nicolás ; Homer, Martin ; Ong, Jason J. ; Christensen, Hannah ; Hill, Darryl ; Looker, Katharine J. ; Horner, Paddy ; Hughes, Gwenda ; Turner, Katy M.E. / Agent-based modelling study of antimicrobial-resistant Neisseria gonorrhoeae transmission in men who have sex with men : Towards individualised diagnosis and treatment. In: Sexual Health. 2019 ; Vol. 16, No. 5. pp. 514-522.
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abstract = "Background: Antimicrobial-resistant (AMR) gonorrhoea is a global public health threat. Discriminatory point-of-care tests (POCT) to detect drug sensitivity are under development, enabling individualised resistance-guided therapy. Methods: An individual-based dynamic transmission model of gonorrhoea infection in MSM living in London has been developed, incorporating ciprofloxacin-sensitive and resistant strains. The time-dependent sexual contact network is captured by periodically restructuring active connections to reflect the transience of contacts. Different strategies to improve treatment selection were explored, including discriminatory POCT and selecting partner treatment based on either the index case or partner susceptibility. Outcomes included population prevalence of gonorrhoea and drug dose counts. Results: It is shown that using POCT to detect ciprofloxacin-sensitive infections could result in a large decrease in ceftriaxone doses (by 70{\%} compared with the reference case in the simulations of this study). It also suggests that ceftriaxone use can be reduced with existing technologies, albeit to a lesser degree either using index case sensitivity profiles to direct treatment of partners, or testing notified partners with strain discriminatory laboratory tests before treatment, reduced ceftriaxone use in our model (by 27{\%} and 47{\%} respectively). Conclusions: POCT to detect ciprofloxacin-sensitive gonorrhoea are likely to dramatically reduce reliance on ceftriaxone, but requires the implementation of new technology. In the meantime, the proportion of unnecessary ceftriaxone treatment by testing partners before treatment could be reduced significantly. Alternatively, index case sensitivity profiles could be used to select effective treatments for partners.",
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Zienkiewicz, AK, Verschueren Van Rees, N, Homer, M, Ong, JJ, Christensen, H, Hill, D, Looker, KJ, Horner, P, Hughes, G & Turner, KME 2019, 'Agent-based modelling study of antimicrobial-resistant Neisseria gonorrhoeae transmission in men who have sex with men: Towards individualised diagnosis and treatment', Sexual Health, vol. 16, no. 5, pp. 514-522. https://doi.org/10.1071/SH18235

Agent-based modelling study of antimicrobial-resistant Neisseria gonorrhoeae transmission in men who have sex with men : Towards individualised diagnosis and treatment. / Zienkiewicz, Adam K.; Verschueren Van Rees, Nicolás; Homer, Martin; Ong, Jason J.; Christensen, Hannah; Hill, Darryl; Looker, Katharine J.; Horner, Paddy; Hughes, Gwenda; Turner, Katy M.E.

In: Sexual Health, Vol. 16, No. 5, 03.09.2019, p. 514-522.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Verschueren Van Rees, Nicolás

AU - Homer, Martin

AU - Ong, Jason J.

AU - Christensen, Hannah

AU - Hill, Darryl

AU - Looker, Katharine J.

AU - Horner, Paddy

AU - Hughes, Gwenda

AU - Turner, Katy M.E.

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N2 - Background: Antimicrobial-resistant (AMR) gonorrhoea is a global public health threat. Discriminatory point-of-care tests (POCT) to detect drug sensitivity are under development, enabling individualised resistance-guided therapy. Methods: An individual-based dynamic transmission model of gonorrhoea infection in MSM living in London has been developed, incorporating ciprofloxacin-sensitive and resistant strains. The time-dependent sexual contact network is captured by periodically restructuring active connections to reflect the transience of contacts. Different strategies to improve treatment selection were explored, including discriminatory POCT and selecting partner treatment based on either the index case or partner susceptibility. Outcomes included population prevalence of gonorrhoea and drug dose counts. Results: It is shown that using POCT to detect ciprofloxacin-sensitive infections could result in a large decrease in ceftriaxone doses (by 70% compared with the reference case in the simulations of this study). It also suggests that ceftriaxone use can be reduced with existing technologies, albeit to a lesser degree either using index case sensitivity profiles to direct treatment of partners, or testing notified partners with strain discriminatory laboratory tests before treatment, reduced ceftriaxone use in our model (by 27% and 47% respectively). Conclusions: POCT to detect ciprofloxacin-sensitive gonorrhoea are likely to dramatically reduce reliance on ceftriaxone, but requires the implementation of new technology. In the meantime, the proportion of unnecessary ceftriaxone treatment by testing partners before treatment could be reduced significantly. Alternatively, index case sensitivity profiles could be used to select effective treatments for partners.

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