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.
Bibliographical noteFunding Information:
AK Zienkiewicz, KME Turner and M Homer gratefully acknowledge funding by BristolBridge (grant number EP/ M027546/1) under the EPSRC Bridging the Gaps between the Engineering and Physical Sciences and Antimicrobial Resistance cross-council AMR initiative. KME Turner, H Christensen and NV van Rees acknowledge support from the NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol. JJ Ong acknowledges support from the Australian National Health and Medical Research Council Sidney Sax Postdoctoral Research Fellowship. KME Turner has received consultancy fees from Aquarius Population for previous work on gonorrhoea/ chlamydia point-of-care tests (2016) and travel expenses from Hologic (2017) for unrelated work. The other authors declare no conflicts of interest.
This work was carried out using the computational facilities of the Advanced Computing Research Centre, University of Bristol – http:// www.bris.ac.uk/acrc/. We also acknowledge Helen Fifer at Public Health England for her assistance in providing data. The study was partially funded by the National Institute of Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions at University of Bristol, in partnership with Public Health England (PHE). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or PHE.
© CSIRO 2019 Open Access.
Copyright 2019 Elsevier B.V., All rights reserved.
- antimicrobial resistance
- point-of-care test
- resistance-guided therapy