| Objectives:(1)To explore the prevalence and the determinants of chlamydia trachomatis(CT)infection among fertile women.(2)To understand the CT genotype and its distribution characteristics of fertile women with positive CT infection of the reproductive tract.(3)To assess the cost-effectiveness of CT infection screening of women’s reproductive tract among fertile women.Methods:(1)The first part of the study adopted a cross-sectional study design.From March to August 2017,a questionnaire survey of fertile women based on community populations in Nanshan District,Shenzhen was conducted to collect sociodemographic characteristics and sexual health-related characteristics,CT infection-related knowledge,sexual behavior-related characteristics,pregnancy and birth history and life behavior characteristics information,and to collect specimens for laboratory testing to determine the prevalence of CT infection among fertile women.By describing the differences in the distribution characteristics of reproductive-age women’s reproductive tract CT infection,the determinants of reproductive-age women’s reproductive tract CT infection were explored.In addition,the nested PCR technology was further used to sequence the 5 housekeeping gene sequences of CT MOMP using MLST to construct the CT genotypes of fertile women who are positive for CT infection of the reproductive tract,and distribution characteristics of subCT genotypes was described based on the different characteristics of CT infection-positive fertile women for cervical swabs.According to the type and distribution of the data,chi-square test,t-test or rank-sum test were used for univariate analysis of CT infection,and multivariable Logistic regression was used to analyze the influencing factors of CT infection in fertile women.(2)In the second part of this study,based on used the data from the first part of the cross-sectional study and ad hoc survey,a decision tree model was adopted to carry out a cost-effectiveness analysis of the fertile women reproductive tract infection screening in the population.The main outcome indicators included the number of untreated cases of CT infection,the number of cases of pelvic inflammatory disease and the lost QALYs value.Results:1)Cross-sectional study of CT infection in fertile women(1)A total of 9661 fertile women were sampled,of which 9312 were eligible for inclusion.The questionnaire information of 101 cases was incomplete,and 4 laboratory specimens could not be subjected to nucleic acid amplification reaction due to the presence of nucleic acid inhibitors.Therefore,9207 subjects were finally included in this study.The age range of the subjects was 20 to 49 years,with an average age of(40.22±7.31)years,8932 cases(97.0%)of Han ethnic group,9144 cases(99.3%)with spouses,and 3895 cases(42.3%)with household registration in Shenzhen.There were 3351 cases(36.4%)with an education level of junior high school or below,and 3309 cases(35.9%)with high school or technical secondary school.(2)Among the 9207 specimens,379 had positive CT,and the positive CT detection rate was 4.12%(95% CI: 3.71%-4.53%).(3)The results of univariate analysis showed that the CT positive group and the CT negative group differed significantly in ethnic group,work status,genital ulcers,history of reproductive tract infection,use of intrauterine contraceptive devices for contraception,age for first sex,frequency of condom use,whether using condom during recent sexual intercourse,commercial sex,the number of sexual partners in the past year,and the number of induced abortions(P<0.05).The CT positive detection rate in the Han ethnic group was significantly lower than that of ethnic minorities.The positive CT detection rate was significantly higher than that of non-employees.The positive CT detection rate for genital ulcers was significantly higher than that for non-genital ulcers.The positive CT detection rates for those with genital tract infections were significantly higher than those without genital tract infections.The positive detection rate of contraceptive CT was significantly higher than that of contraception without the use of intrauterine contraceptive devices.However,the CT positive group and the CT negative group did not differ significantly in age,marital status,household registration,education level,average monthly income,dysuria,burning sensation or abnormal urethral secretion,history of pelvic inflammatory disease,blood transfusion History,whether you know that CT was a sexually transmitted disease,whether you know that CT was curable,extramarital sex,pregnancy times,parity,ectopic pregnancy history,smoking history,drinking history,average daily physical activity time,frequency of drinking tea,frequency of drinking coffee,etc(P>0.05).(4)The results of multivariable logistic regression analysis showed that on-the-job(OR=1.27,95% CI: 1.09-1.45,P=0.042),genital ulcers(OR=1.93,95% CI: 1.42-2.44,P=0.032),history of reproductive tract infection(OR=10.74,95% CI: 8.66-12.82,P<0.001),age of first sex ≤20years(OR=1.61,95% CI: 1.36-1.86,P=0.022),business Sexual behavior(OR=2.09,95% CI: 1.56-2.63,P=0.012),the number of sexual partners in the past year ≥2(OR=2.82,95% CI: 2.03-3.62,P=0.002)and induced abortion Frequency ≥ 2 times(OR=2.39,95% CI: 1.87-2.92,P=0.021)is a risk factor for CT infection;occasionally(OR=0.75,95% CI: 0.53-0.91,P=0.036)and often(OR =0.52,95% CI: 0.31-0.72,P=0.008).Condom use is a protective factor for CT infection.Ethnic group,whether to use an intrauterine contraceptive device for contraception,whether to use a condom in the last one-time life,and the number of induced abortions were not statistically associated with CT infection.(5)CT genotyping results: A total of 379 cervical swabs with positive CT infection specimens were collected,all of which were subjected to PCR amplification of the ompl gene.306 cases were successfully amplified,with a successful amplification rate of 80.74%.A total of E type(25.5%),J type(21.9%),F type(17.3%),D type(14.4%),K type(7.2%),G type(6.9%),H type were found in the genotyping.9 genotypes including type(5.2%),type B(1.0%)and type Ia(0.7%).The genotyping of CT infection is not statistically related to whether there is abnormal leucorrhea,contact bleeding,lower abdominal pain,urinary tract infection,and infertility.2)Cost-effectiveness analysis of CT infection screening of reproductive tract women of childbearing age based on population(1)Project cost estimation: Assuming that 10,000 cases of asymptomatic community women with CT infection in 20 to 35 years old are screened and the positive cases are treated and reviewed,the total cost of the project after discounting is 673,000 yuan,of which the cost of institutional screening accounts for 89.57%,and the cost of personal screening accounted for 10.43%.The total cost of implementing the project was 401,000 yuan more than that of the undeveloped project,and personal cost was saved by 202,600 yuan.(2)Cost-effectiveness analysis and net monetary benefits: the incremental effects of carrying out the screening program compared with the non-screening included: finding and treating 400 more cases of female chlamydia infection,avoiding 65 cases of pelvic inflammatory disease,and recovering 25 QALYs.The ICER values of the three outcome indicators of the screening project were: 1,001 yuan for each case of chlamydia infection detected and treated,6,158 yuan for each case of pelvic inflammatory avoided,and 15,984 yuan for each QALY recovered.In 2017,Shenzhen’s per capita GDP was 183,544 yuan,and the maximum willingness to pay(WTP)was set to be 1 times per capita GDP,that is,WTP=180,000 yuan.The benefit from saving QALYs was 4.554 million yuan,the net currency for the implementation of the screening project is 4,105,300 yuan.(3)Sensitivity analysis: Univariate sensitivity analysis shows that the ICER value per 1 QALY recovered is the most sensitive to the incidence of pelvic inflammatory disease,the prevalence of chlamydia infection,the price of nucleic acid screening,the utility value of chronic pelvic pain,and the discount rate,but threshold was not found.When 10,000 cases of community women aged 20-24 are screened(prevalence rate of 5.67%),or the price of nucleic acid screening drops by 20%,ICUR values are 9894 yuan and 11686 yuan,respectively.The two-factor sensitivity analysis adopted the lowest pelvic inflammatory rate of 6% and the chronic pelvic pain utility value of 50%,and the incremental cost effect of implementing the screening strategy only accounted for 60% of the set willingness to pay.Probabilistic sensitivity analysis shows that when the WTP was RMB18,000 yuan,the probability of cost-effectiveness of screening strategy for chlamydia trachomatis infection among women of reproductive age in community was 45%.When the WTP was 54,000 yuan,the probability of implementing screening strategy in this population was 92%.Conclusions:(1)The positive detection rate of CT in fertile women was 4.12%(95%CI: 3.71%-4.53%).(2)On-the-job,genital ulcers,history of reproductive tract infections,first sexual life age ≤20 years old,commercial sex,the number of sexual partners ≥2 in the past year,and the number of induced abortions ≥2 were the risk factors of CT infection,occasional and frequent condom use was a protective factor for CT infection.(3)Based on the genotyping of CT infection in fertile women of,9genotypes of B,D,E,F,G,H,Ia,J and K were found,of which Type E,Type J and Type F are common genotypes.(4)A population-based CT infection screening program for women’s reproductive tract can achieve good cost-effectiveness and support the implementation of chlamydia infection screening and case management prevention strategies among women of childbearing age. |
PDF Full Text Request