Abstract
Partner notification (PN or contact tracing) is an important aspect of treating bacterial sexually transmitted infections (STIs), such as Chlamydia trachomatis. It facilitates the identification of new infected cases that can be treated through individual case management. PN also acts indirectly by limiting onward transmission in the general population. However, the impact of PN, both at the level of individuals and the population, remains unclear. Since it is difficult to study the effects of PN empirically, mathematical and computational models are useful tools for investigating its potential as a public health intervention. To this end, we developed an individual-based modeling framework called Rstisim. It allows the implementation of different models of STI transmission with various levels of complexity and the reconstruction of the complete dynamic sexual partnership network over any time period. A key feature of this framework is that we can trace an individual’s partnership history in detail and investigate the outcome of different PN strategies for C. trachomatis. For individual case management, the results suggest that notifying three or more partners from the preceding 18 months yields substantial numbers of new cases. In contrast, the successful treatment of current partners is most important for preventing re-infection of index cases and reducing further transmission of C. trachomatis at the population level. The findings of this study demonstrate the difference between individual and population level outcomes of public health interventions for STIs.
Highlights
Partner notification (PN, known as contact tracing) is an integral part of managing several sexually transmitted infections (STIs)
The instantaneous contact model is based on the assumption that sexual contacts happen instantaneously [24], but this model cannot account for a sexual partnership network at cross-section
We studied the effects of PN for C. trachomatis, both at the level of individuals and the population, using a novel, individual-based modeling framework
Summary
Partner notification (PN, known as contact tracing) is an integral part of managing several sexually transmitted infections (STIs). The process of PN for curable STIs includes informing sexual partners of infected people of their exposure, administering presumptive treatment and providing advice about the prevention of future infection [1]. PN has multiple objectives and operates at both individual and population levels [2]. One objective is the identification of new infected index cases who can be treated through individual case management. Another objective is to reduce infection prevalence by preventing onward transmission in the population. While PN is often described as an effective control intervention for different STIs, the relative effects at the level of individuals and the population are not well understood
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