Pub Date : 2024-08-01DOI: 10.1016/j.lana.2024.100846
Hujian Hong , Yijiang He , Yanli Qu
{"title":"Comprehensive exploration of factors and trends in place of death for cancer patients","authors":"Hujian Hong , Yijiang He , Yanli Qu","doi":"10.1016/j.lana.2024.100846","DOIUrl":"10.1016/j.lana.2024.100846","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"Article 100846"},"PeriodicalIF":7.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X2400173X/pdfft?md5=a9ec8d50a5847e232bc56dad6e616a93&pid=1-s2.0-S2667193X2400173X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.lana.2024.100831
Shannon Lange , Kawon V. Kim , Huan Jiang , Kevin D. Shield , Jürgen Rehm , Anselm J.M. Hennis , Renato Oliveira e Souza
Background
The suicide mortality rate has been increasing in Region of the Americas, despite decreasing in all other World Health Organization (WHO) regions. Means restriction is an effective evidence-based intervention for suicide prevention. The objective of the current study was to estimate the impact of implementing national-level means restriction policies (i.e., firearm and pesticide restrictions) on the suicide mortality rate in the Region of the Americas.
Methods
In this ecological modeling study, two counterfactual scenarios were investigated using sex-specific suicide mortality data from the WHO Global Health Estimates database for 2000 to 2019. Forecasted sex-specific age-standardized suicide mortality rates were then estimated for each country for 2020 to 2030. Counterfactual scenario 1 involved modeling the impact of a firearm or pesticide restriction implemented in 2020 for those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, while in counterfactual scenario 2 this threshold was reduced to 20% or more.
Findings
It was estimated that if a firearm or pesticide restriction had been implemented in 2020 in those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, by 2030 the male and female suicide mortality rate in the Region of the Americas would be 20.5% (from 14.5 [95% Confidence Interval [CI]: 14.1, 15.0] per 100,000 males to 11.5 [95% CI: 11.1, 12.0] per 100,000 males) and 11.1% (from 4.5 [95% CI: 4.4, 4.7] per 100,000 females to 4.0 [95% CI: 3.9, 4.2] per 100,000 females) lower than the rate if no such restrictions were implemented, respectively. When the threshold was reduced to 20% or more, minimal additional gains in terms of number of suicides avoided and suicide mortality rate reduction would be achieved.
Interpretation
The implementation of a firearm or pesticide restriction policy in countries where the respective means account for a large proportion of suicides (e.g., at least 40%) could aid the Region of the Americas in achieving the WHO target of a one third reduction in the suicide mortality rate by 2030.
{"title":"Forecasting the impact of means restriction on the suicide mortality rate in the Region of the Americas: an ecological modeling study","authors":"Shannon Lange , Kawon V. Kim , Huan Jiang , Kevin D. Shield , Jürgen Rehm , Anselm J.M. Hennis , Renato Oliveira e Souza","doi":"10.1016/j.lana.2024.100831","DOIUrl":"10.1016/j.lana.2024.100831","url":null,"abstract":"<div><h3>Background</h3><p>The suicide mortality rate has been increasing in Region of the Americas, despite decreasing in all other World Health Organization (WHO) regions. Means restriction is an effective evidence-based intervention for suicide prevention. The objective of the current study was to estimate the impact of implementing national-level means restriction policies (i.e., firearm and pesticide restrictions) on the suicide mortality rate in the Region of the Americas.</p></div><div><h3>Methods</h3><p>In this ecological modeling study, two counterfactual scenarios were investigated using sex-specific suicide mortality data from the WHO Global Health Estimates database for 2000 to 2019. Forecasted sex-specific age-standardized suicide mortality rates were then estimated for each country for 2020 to 2030. Counterfactual scenario 1 involved modeling the impact of a firearm or pesticide restriction implemented in 2020 for those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, while in counterfactual scenario 2 this threshold was reduced to 20% or more.</p></div><div><h3>Findings</h3><p>It was estimated that if a firearm or pesticide restriction had been implemented in 2020 in those countries where the respective means accounted for 40% or more of all suicides for at least one sex in 2019, by 2030 the male and female suicide mortality rate in the Region of the Americas would be 20.5% (from 14.5 [95% Confidence Interval [CI]: 14.1, 15.0] per 100,000 males to 11.5 [95% CI: 11.1, 12.0] per 100,000 males) and 11.1% (from 4.5 [95% CI: 4.4, 4.7] per 100,000 females to 4.0 [95% CI: 3.9, 4.2] per 100,000 females) lower than the rate if no such restrictions were implemented, respectively. When the threshold was reduced to 20% or more, minimal additional gains in terms of number of suicides avoided and suicide mortality rate reduction would be achieved.</p></div><div><h3>Interpretation</h3><p>The implementation of a firearm or pesticide restriction policy in countries where the respective means account for a large proportion of suicides (e.g., at least 40%) could aid the Region of the Americas in achieving the WHO target of a one third reduction in the suicide mortality rate by 2030.</p></div><div><h3>Funding</h3><p>This work received no funding.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"Article 100831"},"PeriodicalIF":7.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001583/pdfft?md5=d755a8591b642f181f4a725457840780&pid=1-s2.0-S2667193X24001583-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.lana.2024.100851
Rohan Borschmann , Stuart A. Kinner , Kyli Hedrick
{"title":"Setting the standards for safeguarding health and wellbeing in US Immigration and Customs Enforcement detention facilities","authors":"Rohan Borschmann , Stuart A. Kinner , Kyli Hedrick","doi":"10.1016/j.lana.2024.100851","DOIUrl":"10.1016/j.lana.2024.100851","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"Article 100851"},"PeriodicalIF":7.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001789/pdfft?md5=ca4039f5405a228aa907e4e1b36f262f&pid=1-s2.0-S2667193X24001789-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.lana.2024.100858
Taissa Vila
{"title":"María Teresa Bourlon – leading oncology care with compassion and innovation","authors":"Taissa Vila","doi":"10.1016/j.lana.2024.100858","DOIUrl":"10.1016/j.lana.2024.100858","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"Article 100858"},"PeriodicalIF":7.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001856/pdfft?md5=49419e88b2111bb665ba0dc987073120&pid=1-s2.0-S2667193X24001856-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1016/j.lana.2024.100849
Stephanie Wang , Kaitlyn Lapen , Khushi Kohli , Fumiko Chino , Edward Christopher Dee
{"title":"Family financial toxicity of cancer in the United States: implications beyond the individual","authors":"Stephanie Wang , Kaitlyn Lapen , Khushi Kohli , Fumiko Chino , Edward Christopher Dee","doi":"10.1016/j.lana.2024.100849","DOIUrl":"10.1016/j.lana.2024.100849","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100849"},"PeriodicalIF":7.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001765/pdfft?md5=0a011ffb4bf0d4cf8b560e2b941fbe61&pid=1-s2.0-S2667193X24001765-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Americas are facing a significant burden of mental health conditions. The Pan American Health Organisation’s regional Strategy for Improving Mental Health and Suicide Prevention is an important milestone in tackling this challenge. However, absence of any focus on gambling as a potential risk to the health and wellbeing represents a serious omission in the Strategy. In this viewpoint, we review existing scholarship demonstrating unequivocal links between gambling and a variety of mental health conditions and related harms. This is followed by an empirically-grounded discussion of how commercial gambling has recently rapidly expanded across the region and how the risks of this expansion have not been sufficiently considered at the policy level. We then present emerging regional evidence of the negative mental health impacts of gambling expansion. The review concludes by proposing possible policy actions to improve control over the gambling industry and reduce ensuing harms on mental health and wellbeing in the region, with a focus on PAHO’s remit.
{"title":"The expansion of gambling across the Americas poses risks to mental health and wellbeing","authors":"Daria Ukhova , Virve Marionneau , Rachel Volberg , Heather Wardle","doi":"10.1016/j.lana.2024.100855","DOIUrl":"10.1016/j.lana.2024.100855","url":null,"abstract":"<div><p>The Americas are facing a significant burden of mental health conditions. The Pan American Health Organisation’s regional Strategy for Improving Mental Health and Suicide Prevention is an important milestone in tackling this challenge. However, absence of any focus on gambling as a potential risk to the health and wellbeing represents a serious omission in the Strategy. In this viewpoint, we review existing scholarship demonstrating unequivocal links between gambling and a variety of mental health conditions and related harms. This is followed by an empirically-grounded discussion of how commercial gambling has recently rapidly expanded across the region and how the risks of this expansion have not been sufficiently considered at the policy level. We then present emerging regional evidence of the negative mental health impacts of gambling expansion. The review concludes by proposing possible policy actions to improve control over the gambling industry and reduce ensuing harms on mental health and wellbeing in the region, with a focus on PAHO’s remit.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100855"},"PeriodicalIF":7.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001820/pdfft?md5=4a1952795cf341051193cd5898958804&pid=1-s2.0-S2667193X24001820-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29DOI: 10.1016/j.lana.2024.100854
Yasna Palmeiro-Silva , Raúl Aravena-Contreras , José Izcue Gana , Rocío González Tapia , Ilan Kelman
Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection.
Funding
This research project was partly funded by ANID Chile and University College London. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.
{"title":"Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis","authors":"Yasna Palmeiro-Silva , Raúl Aravena-Contreras , José Izcue Gana , Rocío González Tapia , Ilan Kelman","doi":"10.1016/j.lana.2024.100854","DOIUrl":"10.1016/j.lana.2024.100854","url":null,"abstract":"<div><p>Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection.</p></div><div><h3>Funding</h3><p>This research project was partly funded by <span>ANID</span> Chile and <span>University College London</span>. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100854"},"PeriodicalIF":7.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001819/pdfft?md5=41c1d86c011e57f74e49abcd2e0a4fc3&pid=1-s2.0-S2667193X24001819-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-28eCollection Date: 2024-08-01DOI: 10.1016/j.lana.2024.100844
Luiza Telles, Ayla Gerk, Madeleine Carroll, Matheus Daniel Faleiro, Thais Barbosa de Oliveira, Abbie Naus, Roseanne Ferreira, Fabio Botelho, Joaquim Bustorff-Silva, David P Mooney, Julia Ferreira
Background: Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources.
Methods: Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed.
Findings: 4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate.
Interpretation: The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil's barriers to adopting non-operative management for pediatric splenic injuries.
Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
{"title":"Frequency of splenectomy for pediatric splenic injury in Brazil: a retrospective analysis.","authors":"Luiza Telles, Ayla Gerk, Madeleine Carroll, Matheus Daniel Faleiro, Thais Barbosa de Oliveira, Abbie Naus, Roseanne Ferreira, Fabio Botelho, Joaquim Bustorff-Silva, David P Mooney, Julia Ferreira","doi":"10.1016/j.lana.2024.100844","DOIUrl":"10.1016/j.lana.2024.100844","url":null,"abstract":"<p><strong>Background: </strong>Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources.</p><p><strong>Methods: </strong>Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed.</p><p><strong>Findings: </strong>4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate.</p><p><strong>Interpretation: </strong>The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil's barriers to adopting non-operative management for pediatric splenic injuries.</p><p><strong>Funding: </strong>This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.</p>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"36 ","pages":"100844"},"PeriodicalIF":7.0,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11338162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-20DOI: 10.1016/j.lana.2024.100845
Yiqing Xia , Chelsea Caya , Véronique Morin , Ameeta E. Singh , Bouchra Serhir , Michael Libman , David M. Goldfarb , Tom Wong , Fanyu Xiu , Richard Bélanger , Jean-Sébastien Touchette , Cédric P. Yansouni , Mathieu Maheu-Giroux
Background
Canadian Arctic communities have experienced sustained syphilis transmission, with diagnoses rates 18-times higher than the national average. Remoteness from laboratory facilities leads to delays between syphilis screening and treatment, contributing to onward transmission. Rapid diagnostic tests can eliminate treatment delays via testing at the point-of-care. This study aims to describe syphilis diagnostic gaps and to estimate the impact of introducing rapid diagnostic tests at the point-of-care on syphilis transmission.
Methods
To assess the population-level impact of deploying rapid diagnostic tests, an individual-based model was developed using detailed surveillance data, population surveys, and a prospective diagnostic accuracy field study. The model was calibrated to syphilis diagnoses (2017–2022) from a community of approximately 1,050 sexually active individuals. The impacts of implementing rapid diagnostic tests using whole blood (sensitivity: 92% for infectious and 81% for non-infectious syphilis; specificity: 99%) from 2023 onward was calculated using the annual median fraction of cumulative new syphilis infections averted over 2023–2032.
Findings
The median modeled syphilis incidence among sexually active individuals was 44 per 1,000 in 2023. Males aged 16–30 years exhibited a 51% lower testing rate than that of their female counterparts. Maintaining all interventions constant at their 2022 levels, implementing rapid diagnostic tests could avert a cumulative 33% (90% credible intervals: 18–43%) and 37% (21–46%) of new syphilis infections over 5 and 10 years, respectively. Increasing testing rates and contact tracing may enhance the effect of rapid diagnostic tests.
Interpretation
Implementing rapid diagnostic tests for syphilis in Arctic communities could reduce infections and enhance control of epidemics. Such effective diagnostic tools could enable rapid outbreak responses by providing same-day testing and treatment at the point-of-care.
{"title":"The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities – a mathematical modeling study","authors":"Yiqing Xia , Chelsea Caya , Véronique Morin , Ameeta E. Singh , Bouchra Serhir , Michael Libman , David M. Goldfarb , Tom Wong , Fanyu Xiu , Richard Bélanger , Jean-Sébastien Touchette , Cédric P. Yansouni , Mathieu Maheu-Giroux","doi":"10.1016/j.lana.2024.100845","DOIUrl":"10.1016/j.lana.2024.100845","url":null,"abstract":"<div><h3>Background</h3><p>Canadian Arctic communities have experienced sustained syphilis transmission, with diagnoses rates 18-times higher than the national average. Remoteness from laboratory facilities leads to delays between syphilis screening and treatment, contributing to onward transmission. Rapid diagnostic tests can eliminate treatment delays via testing at the point-of-care. This study aims to describe syphilis diagnostic gaps and to estimate the impact of introducing rapid diagnostic tests at the point-of-care on syphilis transmission.</p></div><div><h3>Methods</h3><p>To assess the population-level impact of deploying rapid diagnostic tests, an individual-based model was developed using detailed surveillance data, population surveys, and a prospective diagnostic accuracy field study. The model was calibrated to syphilis diagnoses (2017–2022) from a community of approximately 1,050 sexually active individuals. The impacts of implementing rapid diagnostic tests using whole blood (sensitivity: 92% for infectious and 81% for non-infectious syphilis; specificity: 99%) from 2023 onward was calculated using the annual median fraction of cumulative new syphilis infections averted over 2023–2032.</p></div><div><h3>Findings</h3><p>The median modeled syphilis incidence among sexually active individuals was 44 per 1,000 in 2023. Males aged 16–30 years exhibited a 51% lower testing rate than that of their female counterparts. Maintaining all interventions constant at their 2022 levels, implementing rapid diagnostic tests could avert a cumulative 33% (90% credible intervals: 18–43%) and 37% (21–46%) of new syphilis infections over 5 and 10 years, respectively. Increasing testing rates and contact tracing may enhance the effect of rapid diagnostic tests.</p></div><div><h3>Interpretation</h3><p>Implementing rapid diagnostic tests for syphilis in Arctic communities could reduce infections and enhance control of epidemics. Such effective diagnostic tools could enable rapid outbreak responses by providing same-day testing and treatment at the point-of-care.</p></div><div><h3>Funding</h3><p><span>Canadian Institutes of Health Research</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"37 ","pages":"Article 100845"},"PeriodicalIF":7.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001728/pdfft?md5=f00de69eed4118bf8eb42f27fb2fbea5&pid=1-s2.0-S2667193X24001728-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}