The prevalence and incidence of active syphilis in women in Morocco, 1995-2016

Model-based estimation and implications for STI surveillance

Aziza Bennani, Amina El-Kettani, Amina Hançali, Houssine El-Rhilani, Kamal Alami, Mohamed Youbi, Jane Rowley, Laith Aburaddad, Alex Smolak, Melanie Taylor, Guy Mahiané, John Stover, Eline L. Korenromp

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Evolving health priorities and resource constraints mean that countries require data on trends in sexually transmitted infections (STI) burden, to inform program planning and resource allocation. We applied the Spectrum STI estimation tool to estimate the prevalence and incidence of active syphilis in adult women in Morocco over 1995 to 2016. The results from the analysis are being used to inform Morocco’s national HIV/STI strategy, target setting and program evaluation. Methods Syphilis prevalence levels and trends were fitted through logistic regression to data from surveys in antenatal clinics, women attending family planning clinics and other general adult populations, as available post-1995. Prevalence data were adjusted for diagnostic test performance, and for the contribution of higher-risk populations not sampled in surveys. Incidence was inferred from prevalence by adjusting for the average duration of infection with active syphilis. Results In 2016, active syphilis prevalence was estimated to be 0.56% in women 15 to 49 years of age (95% confidence interval, CI: 0.3%-1.0%), and around 21,675 (10,612–37,198) new syphilis infections have occurred. The analysis shows a steady decline in prevalence from 1995, when the prevalence was estimated to be 1.8% (1.0–3.5%). The decline was consistent with decreasing prevalences observed in TB patients, fishermen and prisoners followed over 2000–2012 through sentinel surveillance, and with a decline since 2003 in national HIV incidence estimated earlier through independent modelling. Conclusions Periodic population-based surveys allowed Morocco to estimate syphilis prevalence and incidence trends. This first-ever undertaking engaged and focused national stakeholders, and confirmed the still considerable syphilis burden. The latest survey was done in 2012 and so the trends are relatively uncertain after 2012. From 2017 Morocco plans to implement a system to record data from routine antenatal programmatic screening, which should help update and re-calibrate next trend estimations.

Original languageEnglish
Article numbere0181498
JournalPLoS One
Volume12
Issue number8
DOIs
Publication statusPublished - 1 Aug 2017

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sexually transmitted diseases
Morocco
Syphilis
Sexually Transmitted Diseases
incidence
monitoring
Incidence
Planning
Resource allocation
Logistics
Screening
Health
prison inmates
Sentinel Surveillance
HIV
family planning
Population
program evaluation
Health Priorities
Prisoners

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Bennani, A., El-Kettani, A., Hançali, A., El-Rhilani, H., Alami, K., Youbi, M., ... Korenromp, E. L. (2017). The prevalence and incidence of active syphilis in women in Morocco, 1995-2016: Model-based estimation and implications for STI surveillance. PLoS One, 12(8), [e0181498]. https://doi.org/10.1371/journal.pone.0181498

The prevalence and incidence of active syphilis in women in Morocco, 1995-2016 : Model-based estimation and implications for STI surveillance. / Bennani, Aziza; El-Kettani, Amina; Hançali, Amina; El-Rhilani, Houssine; Alami, Kamal; Youbi, Mohamed; Rowley, Jane; Aburaddad, Laith; Smolak, Alex; Taylor, Melanie; Mahiané, Guy; Stover, John; Korenromp, Eline L.

In: PLoS One, Vol. 12, No. 8, e0181498, 01.08.2017.

Research output: Contribution to journalArticle

Bennani, A, El-Kettani, A, Hançali, A, El-Rhilani, H, Alami, K, Youbi, M, Rowley, J, Aburaddad, L, Smolak, A, Taylor, M, Mahiané, G, Stover, J & Korenromp, EL 2017, 'The prevalence and incidence of active syphilis in women in Morocco, 1995-2016: Model-based estimation and implications for STI surveillance', PLoS One, vol. 12, no. 8, e0181498. https://doi.org/10.1371/journal.pone.0181498
Bennani, Aziza ; El-Kettani, Amina ; Hançali, Amina ; El-Rhilani, Houssine ; Alami, Kamal ; Youbi, Mohamed ; Rowley, Jane ; Aburaddad, Laith ; Smolak, Alex ; Taylor, Melanie ; Mahiané, Guy ; Stover, John ; Korenromp, Eline L. / The prevalence and incidence of active syphilis in women in Morocco, 1995-2016 : Model-based estimation and implications for STI surveillance. In: PLoS One. 2017 ; Vol. 12, No. 8.
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abstract = "Background Evolving health priorities and resource constraints mean that countries require data on trends in sexually transmitted infections (STI) burden, to inform program planning and resource allocation. We applied the Spectrum STI estimation tool to estimate the prevalence and incidence of active syphilis in adult women in Morocco over 1995 to 2016. The results from the analysis are being used to inform Morocco’s national HIV/STI strategy, target setting and program evaluation. Methods Syphilis prevalence levels and trends were fitted through logistic regression to data from surveys in antenatal clinics, women attending family planning clinics and other general adult populations, as available post-1995. Prevalence data were adjusted for diagnostic test performance, and for the contribution of higher-risk populations not sampled in surveys. Incidence was inferred from prevalence by adjusting for the average duration of infection with active syphilis. Results In 2016, active syphilis prevalence was estimated to be 0.56{\%} in women 15 to 49 years of age (95{\%} confidence interval, CI: 0.3{\%}-1.0{\%}), and around 21,675 (10,612–37,198) new syphilis infections have occurred. The analysis shows a steady decline in prevalence from 1995, when the prevalence was estimated to be 1.8{\%} (1.0–3.5{\%}). The decline was consistent with decreasing prevalences observed in TB patients, fishermen and prisoners followed over 2000–2012 through sentinel surveillance, and with a decline since 2003 in national HIV incidence estimated earlier through independent modelling. Conclusions Periodic population-based surveys allowed Morocco to estimate syphilis prevalence and incidence trends. This first-ever undertaking engaged and focused national stakeholders, and confirmed the still considerable syphilis burden. The latest survey was done in 2012 and so the trends are relatively uncertain after 2012. From 2017 Morocco plans to implement a system to record data from routine antenatal programmatic screening, which should help update and re-calibrate next trend estimations.",
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AU - Bennani, Aziza

AU - El-Kettani, Amina

AU - Hançali, Amina

AU - El-Rhilani, Houssine

AU - Alami, Kamal

AU - Youbi, Mohamed

AU - Rowley, Jane

AU - Aburaddad, Laith

AU - Smolak, Alex

AU - Taylor, Melanie

AU - Mahiané, Guy

AU - Stover, John

AU - Korenromp, Eline L.

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N2 - Background Evolving health priorities and resource constraints mean that countries require data on trends in sexually transmitted infections (STI) burden, to inform program planning and resource allocation. We applied the Spectrum STI estimation tool to estimate the prevalence and incidence of active syphilis in adult women in Morocco over 1995 to 2016. The results from the analysis are being used to inform Morocco’s national HIV/STI strategy, target setting and program evaluation. Methods Syphilis prevalence levels and trends were fitted through logistic regression to data from surveys in antenatal clinics, women attending family planning clinics and other general adult populations, as available post-1995. Prevalence data were adjusted for diagnostic test performance, and for the contribution of higher-risk populations not sampled in surveys. Incidence was inferred from prevalence by adjusting for the average duration of infection with active syphilis. Results In 2016, active syphilis prevalence was estimated to be 0.56% in women 15 to 49 years of age (95% confidence interval, CI: 0.3%-1.0%), and around 21,675 (10,612–37,198) new syphilis infections have occurred. The analysis shows a steady decline in prevalence from 1995, when the prevalence was estimated to be 1.8% (1.0–3.5%). The decline was consistent with decreasing prevalences observed in TB patients, fishermen and prisoners followed over 2000–2012 through sentinel surveillance, and with a decline since 2003 in national HIV incidence estimated earlier through independent modelling. Conclusions Periodic population-based surveys allowed Morocco to estimate syphilis prevalence and incidence trends. This first-ever undertaking engaged and focused national stakeholders, and confirmed the still considerable syphilis burden. The latest survey was done in 2012 and so the trends are relatively uncertain after 2012. From 2017 Morocco plans to implement a system to record data from routine antenatal programmatic screening, which should help update and re-calibrate next trend estimations.

AB - Background Evolving health priorities and resource constraints mean that countries require data on trends in sexually transmitted infections (STI) burden, to inform program planning and resource allocation. We applied the Spectrum STI estimation tool to estimate the prevalence and incidence of active syphilis in adult women in Morocco over 1995 to 2016. The results from the analysis are being used to inform Morocco’s national HIV/STI strategy, target setting and program evaluation. Methods Syphilis prevalence levels and trends were fitted through logistic regression to data from surveys in antenatal clinics, women attending family planning clinics and other general adult populations, as available post-1995. Prevalence data were adjusted for diagnostic test performance, and for the contribution of higher-risk populations not sampled in surveys. Incidence was inferred from prevalence by adjusting for the average duration of infection with active syphilis. Results In 2016, active syphilis prevalence was estimated to be 0.56% in women 15 to 49 years of age (95% confidence interval, CI: 0.3%-1.0%), and around 21,675 (10,612–37,198) new syphilis infections have occurred. The analysis shows a steady decline in prevalence from 1995, when the prevalence was estimated to be 1.8% (1.0–3.5%). The decline was consistent with decreasing prevalences observed in TB patients, fishermen and prisoners followed over 2000–2012 through sentinel surveillance, and with a decline since 2003 in national HIV incidence estimated earlier through independent modelling. Conclusions Periodic population-based surveys allowed Morocco to estimate syphilis prevalence and incidence trends. This first-ever undertaking engaged and focused national stakeholders, and confirmed the still considerable syphilis burden. The latest survey was done in 2012 and so the trends are relatively uncertain after 2012. From 2017 Morocco plans to implement a system to record data from routine antenatal programmatic screening, which should help update and re-calibrate next trend estimations.

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