背景:本研究旨在研究淋病奈瑟菌(NG)在异性性工作网络(HSWN)中的传播动态,以及性行为和干预措施的变化对NG流行病学的影响。
方法:该研究采用基于个人的数学模型来模拟涉及女性性工作者(FSW)及其客户的性网络中的NG传播动态,主要集中在中东和北非地区。还使用了确定性模型来描述从客户到其配偶的NG传输。
结果:HSWN中的NG流行病学表现出两种不同的模式。在常见的低伙伴数HSWN中,NG发病率的很大一部分发生在FSW中,FSW中的NG患病率比客户高13倍,客户比他们的配偶高三倍。干预措施大大降低了发病率。将安全套的使用从10%增加到50%降低了FSW中的NG患病率,客户,和他们的配偶从12.2%上升到6.4%,1.2%至0.5%,以及0.4%至0.2%,分别。FSW的对症治疗覆盖率从0%增加到100%,患病率从10.6%降低到4.5%,0.8%至0.4%,0.3%至0.1%,分别。FSW的无症状治疗覆盖率从0%增加到50%,患病率从8.2%降低到0.4%,0.6%至0.1%,以及0.2%至0.0%,分别,当覆盖率超过50%时,患病率非常低。在高合作伙伴数量的HSWN中,FSW的患病率在高水平上饱和,绝大多数发病率发生在客户及其配偶中,干预措施增加的影响有限。
结论:HSWNs的NG流行病学通常是一种“脆弱流行病学”,即使干预措施是渐进的,也可以对一系列干预措施做出反应。部分有效,并且仅适用于FSW。
BACKGROUND: This study aimed to examine the transmission dynamics of Neisseria gonorrhoeae (NG) in heterosexual sex work networks (HSWNs) and the impact of variation in sexual behavior and interventions on NG epidemiology.
METHODS: The study employed an individual-based mathematical model to simulate NG transmission dynamics in sexual networks involving female sex workers (FSWs) and their clients, primarily focusing on the Middle East and North Africa region. A deterministic model was also used to describe NG transmission from clients to their spouses.
RESULTS: NG epidemiology in HSWNs displays two distinct patterns. In the common low-partner-number HSWNs, a significant proportion of NG incidence occurs among FSWs, with NG prevalence 13 times higher among FSWs than clients, and three times higher among clients than their spouses. Interventions substantially reduce incidence. Increasing condom use from 10 % to 50 % lowers NG prevalence among FSWs, clients, and their spouses from 12.2 % to 6.4 %, 1.2 % to 0.5 %, and 0.4 % to 0.2 %, respectively. Increasing symptomatic treatment coverage among FSWs from 0 % to 100 % decreases prevalence from 10.6 % to 4.5 %, 0.8 % to 0.4 %, and 0.3 % to 0.1 %, respectively. Increasing asymptomatic treatment coverage among FSWs from 0 % to 50 % decreases prevalence from 8.2 % to 0.4 %, 0.6 % to 0.1 %, and 0.2 % to 0.0 %, respectively, with very low prevalence when coverage exceeds 50 %. In high-partner-number HSWNs, prevalence among FSWs saturates at a high level, and the vast majority of incidence occurs among clients and their spouses, with a limited impact of incremental increases in interventions.
CONCLUSIONS: NG epidemiology in HSWNs is typically a \"fragile epidemiology\" that is responsive to a range of interventions even if the interventions are incremental, partially efficacious, and only applied to FSWs.