Asset Details

  • Description:
  • Influence diagrams showing the flow of patients through the model, assuming standard care (A) or point of care (B) pathways for chlamydia and gonorrhoea testing and treatment for genitourinary medicine clinic attendees. (A) Standard care genitourinary medicine clinic attendees based on data from Genitourinary Medicine Clinic Activity Dataset (GUMCAD) 2011,1 illustrated using chlamydial infection in men. Numbers based on a hypothetical cohort of 1000 male attendances and are rounded to the nearest whole number for illustration. Values <1 are not shown for simplicity. (Note: Attendees who report being a sexual partner of an infected individual are also presumptively treated (partner treatment). These can be explicitly included in the model as ‘partners’, but are not incorporated in this illustration of ‘index’ individuals, but in the complete model are added to the total of overtreatment and effective presumptive treatment.) (a) 1000 men attend of whom 350 have any symptoms at entry into clinic (ie, costed as symptomatic pathway). (b) 956 not treated presumptively, await test result=650 without symptoms (65%)+306: 87%*350 with symptoms. (c) 44=13%*350 with specific symptoms are treated presumptively. This assumes 70% of infections are correctly treated presumptively and that 5% of those not infected (but symptomatic of something else) are overtreated. (d), (e), (k), (n), (o) Show progression to development of complications, numbers not shown as <1. (e) See (d). (f) Repeat tests. (g) 881=956–75 (94% of those tested are negative). (h) 57 (6.0% of those not presumptively treated) are infected=(650*6.9% asymptomatic + 306*4.0% symptomatic) (not chlamydial). (i). 15 of those presumptively treated (35%*44) were not infected. (j) 29 of those presumptively treated (65%*44) were infected. (k), (n), (o) All relate to progression to complications which are rare events dealt with in the model not enumerated for simplicity here (<1). (l) 82 of those receiving treatment for chlamydia recover and become negative (95% treatment effectiveness). (m) Four fail treatment and remain positive (5% failure. Note: these would not routinely receive test of cure for chlamydia). From this illustration we can calculate outcomes: (1) Total chlamydial infections are 86 (8.6%)=29 (presumptive) +57 (wait result). (2). Proportion of infections treated presumptively is 33%=29/86. (3) Number of unnecessary treatments 15: represents 15%=15/(86+15). (B) Pathway for point of care GUM clinic attendees based on profiles from GUMCAD 2011, illustrated using chlamydial infection in men. Numbers based on attendance of 1000 men and are rounded to nearest whole number for illustration. Values <1 are not shown for simplicity. (a) 1000 men attend. (b) 914 (91.3% are not infected and do not have complications in the same day). (c) 86 are correctly diagnosed and treated (8.6%). (d), (g), (h) Show progression to development of complications, numbers not shown as <1. (e) 82 of those receiving treatment for chlamydia recover and become negative (95% treatment effectiveness). (f) Four fail treatment and remain positive (5% failure. Note: these would not routinely receive test of cure for chlamydia). From this illustration we can calculate outcomes: (1) Total chlamydial infections are 86 (8.6%). (2) Proportion of infections treated presumptively is 0. (3) Number of unnecessary treatments is 0.
  • License:
  • Rights Managed
  • Rights Holder:
  • BMJ
  • License Rights Holder:
  • Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
  • Asset Type:
  • Image
  • Asset Subtype:
  • Photo
  • Image Orientation:
  • Landscape
  • Image Dimensions:
  • 1280 x 1192
  • Image File Size:
  • 138 KB
  • Creator:
  • Katherine M E Turner, Jeff Round, Patrick Horner, John Macleod, Simon Goldenberg, Arminder Deol, Elisabeth J Adams
  • Credit:
  • Turner, K. M. E., et al., Sexually Transmitted Infections, 90(2), 104.
  • Collection:
  • Keywords:
  • Chlamydia Trachomatis, Diagnosis, Gonorrhoea, Cost-Effectiveness, Mathematical Model
  • Restrictions:
  • Property Release:
  • No
  • Model Release:
  • No
  • Purchasable:
  • Yes
  • Sensitive Materials:
  • No
  • Article Authors:
  • Katherine M E Turner, Jeff Round, Patrick Horner, John Macleod, Simon Goldenberg, Arminder Deol, Elisabeth J Adams
  • Article Copyright Year:
  • 2014
  • Publication Volume:
  • 90
  • Publication Issue:
  • 2
  • Publication Date:
  • 11/22/2013
  • DOI:
  • https://doi.org/10.1136/sextrans-2013-051147

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