A Comparison of Two Mathematical Modeling Frameworks for Evaluating Sexually Transmitted Infection Epidemiology.

Abstract:

BACKGROUND:Different models of sexually transmitted infections (STIs) can yield substantially different conclusions about STI epidemiology, and it is important to understand how and why models differ. Frequency-dependent models make the simplifying assumption that STI incidence is proportional to STI prevalence in the population, whereas network models calculate STI incidence more realistically by classifying individuals according to their partners' STI status. METHODS:We assessed a deterministic frequency-dependent model approximation to a microsimulation network model of STIs in South Africa. Sexual behavior and demographic parameters were identical in the 2 models. Six STIs were simulated using each model: HIV, herpes, syphilis, gonorrhea, chlamydia, and trichomoniasis. RESULTS:For all 6 STIs, the frequency-dependent model estimated a higher STI prevalence than the network model, with the difference between the 2 models being relatively large for the curable STIs. When the 2 models were fitted to the same STI prevalence data, the best-fitting parameters differed substantially between models, with the frequency-dependent model suggesting more immunity and lower transmission probabilities. The fitted frequency-dependent model estimated that the effects of a hypothetical elimination of concurrent partnerships and a reduction in commercial sex were both smaller than estimated by the fitted network model, whereas the latter model estimated a smaller impact of a reduction in unprotected sex in spousal relationships. CONCLUSIONS:The frequency-dependent assumption is problematic when modeling short-term STIs. Frequency-dependent models tend to underestimate the importance of high-risk groups in sustaining STI epidemics, while overestimating the importance of long-term partnerships and low-risk groups.

journal_name

Sex Transm Dis

authors

Johnson LF,Geffen N

doi

10.1097/OLQ.0000000000000412

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

139-46

issue

3

eissn

0148-5717

issn

1537-4521

pii

00007435-201603000-00001

journal_volume

43

pub_type

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