Investigating the effects of accelerated partner therapy (APT) on chlamydia transmission in Britain: a mathematical modelling study

Understanding the effects of partner notification (PN) on the transmission of chlamydia, the most prevalent bacterial sexual transmitted infection worldwide, is critical for implementing optimal control strategies. Accelerated partner therapy (APT) aims to increase the numbers of partners treated and reduce the time to partner treatment. Our objective was to study the effects of APT interventions on partner treatment and chlamydia transmission in order to better understand the results of LUSTRUM, an APT cross-over cluster randomised controlled trial in the UK. We developed a novel deterministic, population-based chlamydia transmission model including the process of PN. We considered a population aged 16-34 years and calibrated the model to sexual behaviour data between people of the opposite-sex and chlamydia prevalence data reported by 3,671 participants in Britains third National Survey of Sexual Attitudes and Lifestyles (Natsal-3, 2010-2012) using Approximate Bayesian Computation (ABC). We investigated the potential effects of APT on chlamydia transmission by increasing the number of treated partners and reducing the time to partner treatment compared to standard PN. The median prevalence of chlamydia in the model was 1.84% (95% credible interval, CrI: 1.60%-2.62%) in women and 1.78% (95% CrI: 1.13%-2.14%) in men. Chlamydia positivity was highest in partners of symptomatic index cases with low sexual activity. Infected partners were typically asymptomatic and belonged to the high sexual activity group, i.e., are naturally those infected individuals that will contribute most to onward transmission. Reducing the time to partner treatment without achieving higher numbers of partners treated had only minor effects on reducing chlamydia prevalence. In contrast, the model predicts that a potential increase in the number of partners treated from current levels in Britain (0.51, 95% CrI: 0.21-0.80) by 25% would reduce chlamydia prevalence by 18% (95% CrI: 5%-44%) in both women in men within 5 years. These results suggest that APT, through a potential increase in the proportion of partners treated, would be an effective method to reduce ongoing chlamydia transmission in Britain.