Population-level diagnosis and care cascade for chlamydia in Australia

Richard T. Gray, Denton Callander, Jane S. Hocking, Skye McGregor, Hamish McManus, Amalie Dyda, Clarissa Moreira, Sabine Braat, Belinda Hengel, James Ward, David P. Wilson, Basil Donovan, John M. Kaldor, Rebecca J. Guy

Research output: Contribution to journalArticle

Abstract

Objectives: Key strategies to control chlamydia include testing, treatment, partner management and re-testing. We developed a diagnosis and care cascade for chlamydia to highlight gaps in control strategies nationally and to inform efforts to optimise control programmes. Methods: The Australian Chlamydia Cascade was organised into four steps: (1) annual number of new chlamydia infections (including re-infections); (2) annual number of chlamydia diagnoses; (3) annual number of diagnoses treated; (4) annual number of diagnoses followed by a re-test for chlamydia within 42-180 days of diagnosis. For 2016, we estimated the number of infections among young men and women aged 15-29 years in each of these steps using a combination of mathematical modelling, national notification data, sentinel surveillance data and previous research studies. Results: Among young people in Australia, there were an estimated 248 580 (range, 240 690-256 470) new chlamydia infections in 2016 (96 470 in women; 152 100 in men) of which 70 164 were diagnosed (28.2% overall: women 43.4%, men 18.6%). Of the chlamydia infections diagnosed, 65 490 (range, 59 640-70 160) were treated (93.3% across all populations), but only 11 330 (range, 7660-16 285) diagnoses were followed by a re-test within 42-180 days (17.3% overall: women 20.6%, men 12.5%) of diagnosis. Conclusions: The greatest gaps in the Australian Chlamydia Cascade for young people were in the diagnosis and re-testing steps, with 72% of infections undiagnosed and 83% of those diagnosed not re-tested: both were especially low among men. Treatment rates were also lower than recommended by guidelines. Our cascade highlights the need for enhanced strategies to improve treatment and re-testing coverage such as short message service reminders, point-of-care and postal test kits.

LanguageEnglish
JournalSexually Transmitted Infections
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • care cascade
  • control
  • genital chlamydia trachomatis
  • high-income setting
  • incidence
  • sti guidelines
  • surveillance and monitoring

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

Cite this

Gray, R. T., Callander, D., Hocking, J. S., McGregor, S., McManus, H., Dyda, A., ... Guy, R. J. (2019). Population-level diagnosis and care cascade for chlamydia in Australia. Sexually Transmitted Infections. https://doi.org/10.1136/sextrans-2018-053801
Gray, Richard T. ; Callander, Denton ; Hocking, Jane S. ; McGregor, Skye ; McManus, Hamish ; Dyda, Amalie ; Moreira, Clarissa ; Braat, Sabine ; Hengel, Belinda ; Ward, James ; Wilson, David P. ; Donovan, Basil ; Kaldor, John M. ; Guy, Rebecca J. / Population-level diagnosis and care cascade for chlamydia in Australia. In: Sexually Transmitted Infections. 2019.
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abstract = "Objectives: Key strategies to control chlamydia include testing, treatment, partner management and re-testing. We developed a diagnosis and care cascade for chlamydia to highlight gaps in control strategies nationally and to inform efforts to optimise control programmes. Methods: The Australian Chlamydia Cascade was organised into four steps: (1) annual number of new chlamydia infections (including re-infections); (2) annual number of chlamydia diagnoses; (3) annual number of diagnoses treated; (4) annual number of diagnoses followed by a re-test for chlamydia within 42-180 days of diagnosis. For 2016, we estimated the number of infections among young men and women aged 15-29 years in each of these steps using a combination of mathematical modelling, national notification data, sentinel surveillance data and previous research studies. Results: Among young people in Australia, there were an estimated 248 580 (range, 240 690-256 470) new chlamydia infections in 2016 (96 470 in women; 152 100 in men) of which 70 164 were diagnosed (28.2{\%} overall: women 43.4{\%}, men 18.6{\%}). Of the chlamydia infections diagnosed, 65 490 (range, 59 640-70 160) were treated (93.3{\%} across all populations), but only 11 330 (range, 7660-16 285) diagnoses were followed by a re-test within 42-180 days (17.3{\%} overall: women 20.6{\%}, men 12.5{\%}) of diagnosis. Conclusions: The greatest gaps in the Australian Chlamydia Cascade for young people were in the diagnosis and re-testing steps, with 72{\%} of infections undiagnosed and 83{\%} of those diagnosed not re-tested: both were especially low among men. Treatment rates were also lower than recommended by guidelines. Our cascade highlights the need for enhanced strategies to improve treatment and re-testing coverage such as short message service reminders, point-of-care and postal test kits.",
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author = "Gray, {Richard T.} and Denton Callander and Hocking, {Jane S.} and Skye McGregor and Hamish McManus and Amalie Dyda and Clarissa Moreira and Sabine Braat and Belinda Hengel and James Ward and Wilson, {David P.} and Basil Donovan and Kaldor, {John M.} and Guy, {Rebecca J.}",
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Gray, RT, Callander, D, Hocking, JS, McGregor, S, McManus, H, Dyda, A, Moreira, C, Braat, S, Hengel, B, Ward, J, Wilson, DP, Donovan, B, Kaldor, JM & Guy, RJ 2019, 'Population-level diagnosis and care cascade for chlamydia in Australia', Sexually Transmitted Infections. https://doi.org/10.1136/sextrans-2018-053801

Population-level diagnosis and care cascade for chlamydia in Australia. / Gray, Richard T.; Callander, Denton; Hocking, Jane S.; McGregor, Skye; McManus, Hamish; Dyda, Amalie; Moreira, Clarissa; Braat, Sabine; Hengel, Belinda; Ward, James; Wilson, David P.; Donovan, Basil; Kaldor, John M.; Guy, Rebecca J.

In: Sexually Transmitted Infections, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Population-level diagnosis and care cascade for chlamydia in Australia

AU - Gray, Richard T.

AU - Callander, Denton

AU - Hocking, Jane S.

AU - McGregor, Skye

AU - McManus, Hamish

AU - Dyda, Amalie

AU - Moreira, Clarissa

AU - Braat, Sabine

AU - Hengel, Belinda

AU - Ward, James

AU - Wilson, David P.

AU - Donovan, Basil

AU - Kaldor, John M.

AU - Guy, Rebecca J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: Key strategies to control chlamydia include testing, treatment, partner management and re-testing. We developed a diagnosis and care cascade for chlamydia to highlight gaps in control strategies nationally and to inform efforts to optimise control programmes. Methods: The Australian Chlamydia Cascade was organised into four steps: (1) annual number of new chlamydia infections (including re-infections); (2) annual number of chlamydia diagnoses; (3) annual number of diagnoses treated; (4) annual number of diagnoses followed by a re-test for chlamydia within 42-180 days of diagnosis. For 2016, we estimated the number of infections among young men and women aged 15-29 years in each of these steps using a combination of mathematical modelling, national notification data, sentinel surveillance data and previous research studies. Results: Among young people in Australia, there were an estimated 248 580 (range, 240 690-256 470) new chlamydia infections in 2016 (96 470 in women; 152 100 in men) of which 70 164 were diagnosed (28.2% overall: women 43.4%, men 18.6%). Of the chlamydia infections diagnosed, 65 490 (range, 59 640-70 160) were treated (93.3% across all populations), but only 11 330 (range, 7660-16 285) diagnoses were followed by a re-test within 42-180 days (17.3% overall: women 20.6%, men 12.5%) of diagnosis. Conclusions: The greatest gaps in the Australian Chlamydia Cascade for young people were in the diagnosis and re-testing steps, with 72% of infections undiagnosed and 83% of those diagnosed not re-tested: both were especially low among men. Treatment rates were also lower than recommended by guidelines. Our cascade highlights the need for enhanced strategies to improve treatment and re-testing coverage such as short message service reminders, point-of-care and postal test kits.

AB - Objectives: Key strategies to control chlamydia include testing, treatment, partner management and re-testing. We developed a diagnosis and care cascade for chlamydia to highlight gaps in control strategies nationally and to inform efforts to optimise control programmes. Methods: The Australian Chlamydia Cascade was organised into four steps: (1) annual number of new chlamydia infections (including re-infections); (2) annual number of chlamydia diagnoses; (3) annual number of diagnoses treated; (4) annual number of diagnoses followed by a re-test for chlamydia within 42-180 days of diagnosis. For 2016, we estimated the number of infections among young men and women aged 15-29 years in each of these steps using a combination of mathematical modelling, national notification data, sentinel surveillance data and previous research studies. Results: Among young people in Australia, there were an estimated 248 580 (range, 240 690-256 470) new chlamydia infections in 2016 (96 470 in women; 152 100 in men) of which 70 164 were diagnosed (28.2% overall: women 43.4%, men 18.6%). Of the chlamydia infections diagnosed, 65 490 (range, 59 640-70 160) were treated (93.3% across all populations), but only 11 330 (range, 7660-16 285) diagnoses were followed by a re-test within 42-180 days (17.3% overall: women 20.6%, men 12.5%) of diagnosis. Conclusions: The greatest gaps in the Australian Chlamydia Cascade for young people were in the diagnosis and re-testing steps, with 72% of infections undiagnosed and 83% of those diagnosed not re-tested: both were especially low among men. Treatment rates were also lower than recommended by guidelines. Our cascade highlights the need for enhanced strategies to improve treatment and re-testing coverage such as short message service reminders, point-of-care and postal test kits.

KW - care cascade

KW - control

KW - genital chlamydia trachomatis

KW - high-income setting

KW - incidence

KW - sti guidelines

KW - surveillance and monitoring

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U2 - 10.1136/sextrans-2018-053801

DO - 10.1136/sextrans-2018-053801

M3 - Article

JO - Sexually Transmitted Infections

T2 - Sexually Transmitted Infections

JF - Sexually Transmitted Infections

SN - 1368-4973

ER -