{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:39:02Z","timestamp":1787017142977,"version":"build-2736575974"},"reference-count":57,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2017,1,14]]},"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop a tool for estimating national trends in adult prevalence of sexually transmitted infections by low- and middle-income countries, using standardised, routinely collected programme indicator data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Spectrum-STI model fits time trends in the prevalence of active syphilis through logistic regression on prevalence data from antenatal clinic-based surveys, routine antenatal screening and general population surveys where available, weighting data by their national coverage and representativeness. Gonorrhoea prevalence was fitted as a moving average on population surveys (from the country, neighbouring countries and historic regional estimates), with trends informed additionally by urethral discharge case reports, where these were considered to have reasonably stable completeness. Prevalence data were adjusted for diagnostic test performance, high-risk populations not sampled, urban\/rural and male\/female prevalence ratios, using WHO's assumptions from latest global and regional-level estimations. Uncertainty intervals were obtained by bootstrap resampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Estimated syphilis prevalence (in men and women) declined from 1.9% (95% CI 1.1% to 3.4%) in 2000 to 1.5% (1.3% to 1.8%) in 2016 in Zimbabwe, and from 1.5% (0.76% to 1.9%) to 0.55% (0.30% to 0.93%) in Morocco. At these time points, gonorrhoea estimates for women aged 15\u201349\u2005years were 2.5% (95% CI 1.1% to 4.6%) and 3.8% (1.8% to 6.7%) in Zimbabwe; and 0.6% (0.3% to 1.1%) and 0.36% (0.1% to 1.0%) in Morocco, with male gonorrhoea prevalences 14% lower than female prevalence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This epidemiological framework facilitates data review, validation and strategic analysis, prioritisation of data collection needs and surveillance strengthening by national experts. We estimated ongoing syphilis declines in both Zimbabwe and Morocco. For gonorrhoea, time trends were less certain, lacking recent population-based surveys.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2016-052953","type":"journal-article","created":{"date-parts":[[2017,3,21]],"date-time":"2017-03-21T20:54:13Z","timestamp":1490129653000},"page":"599-606","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Estimating prevalence trends in adult gonorrhoea and syphilis in low- and middle-income countries with the Spectrum-STI model: results for Zimbabwe and Morocco from 1995 to 2016"],"prefix":"10.1136","volume":"93","author":[{"given":"Eline L","family":"Korenromp","sequence":"first","affiliation":[{"name":"Avenir Health, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Mahian\u00e9","sequence":"additional","affiliation":[{"name":"Avenir Health, Glastonbury, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Rowley","sequence":"additional","affiliation":[{"name":"London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nico","family":"Nagelkerke","sequence":"additional","affiliation":[{"name":"Malawi-Liverpool Wellcome Trust, Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laith","family":"Abu-Raddad","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College\u2014Qatar, Cornell University, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Ndowa","sequence":"additional","affiliation":[{"name":"Skin & Genito-Urinary Medicine Clinic, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina","family":"El-Kettani","sequence":"additional","affiliation":[{"name":"Ministry of Health, Direction de l'Epid\u00e9miologie & Service de Maladies Sexuellement Transmissibles, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houssine","family":"El-Rhilani","sequence":"additional","affiliation":[{"name":"UNAIDS Morocco Country Office, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Mayaud","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R Matthew","family":"Chico","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carel","family":"Pretorius","sequence":"additional","affiliation":[{"name":"Avenir Health, Glastonbury, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendall","family":"Hecht","sequence":"additional","affiliation":[{"name":"Avenir Health, Glastonbury, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Wi","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,3,21]]},"reference":[{"key":"2025081305110704000_93.8.599.1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0143304"},{"key":"2025081305110704000_93.8.599.2","unstructured":"Holmes K . Sexually transmitted diseases. 4th edn. New York City: McGraw-Hill Medical, 2008."},{"key":"2025081305110704000_93.8.599.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60692-4"},{"issue":"1","key":"2025081305110704000_93.8.599.4","first-page":"S12","article-title":"Global prevalence and incidence estimates of selected curable STDs","volume":"74","author":"Gerbase","year":"1998","journal-title":"Sex Transm Infect"},{"key":"2025081305110704000_93.8.599.5","unstructured":"World Health Organization. Global incidence and prevalence of selected curable sexually transmitted infections\u20142008. Geneva, 2012."},{"key":"2025081305110704000_93.8.599.6","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1016\/S0140-6736(14)61055-2","article-title":"Meeting demand for family planning within a generation: the post-2015 agenda","volume":"385","author":"Fabic","year":"2014","journal-title":"Lancet"},{"key":"2025081305110704000_93.8.599.7","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000363785.73450.5a"},{"key":"2025081305110704000_93.8.599.8","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-009-0505-y"},{"key":"2025081305110704000_93.8.599.9","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2012-050640"},{"key":"2025081305110704000_93.8.599.10","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2008.029868"},{"key":"2025081305110704000_93.8.599.11","doi-asserted-by":"crossref","unstructured":"Stover J , McKinnon R , Winfrey B . Spectrum: a model platform for linking maternal and child survival interventions with AIDS, family planning and demographic projections. Int J Epidemiol 2010;39:i7\u201310. doi:10.1093\/ije\/dyq016","DOI":"10.1093\/ije\/dyq016"},{"key":"2025081305110704000_93.8.599.12","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s12916-016-0608-4","article-title":"TIME Impact\u2014a new user-friendly tuberculosis (TB) model to inform TB policy decisions","volume":"14","author":"Houben","year":"2016","journal-title":"BMC Med"},{"key":"2025081305110704000_93.8.599.13","doi-asserted-by":"crossref","unstructured":"Korenromp EL , Mahian\u00e9 G , Hamilton M , et al . Malaria intervention scale-up in Africa: effectiveness predictions for health program planning tools, based on dynamic transmission modelling. Malar J 2016;15. doi:10.1186\/s12936-016-1461-9","DOI":"10.1186\/s12936-016-1461-9"},{"key":"2025081305110704000_93.8.599.14","doi-asserted-by":"crossref","unstructured":"Hamilton M , Mahian\u00e9 G , Werst E , et al . Spectrum-Malaria: a user-friendly projection tool for health impact assessment and strategic planning for malaria programs in sub-Saharan Africa. Malar J 2017; doi:10.1186\/s12936-017-1705-3.","DOI":"10.1186\/s12936-017-1705-3"},{"key":"2025081305110704000_93.8.599.15","unstructured":"World Health Organization. Global health sector strategy on sexually transmitted infections, 2016\u20132021. Report. Geneva, 2016."},{"key":"2025081305110704000_93.8.599.16","unstructured":"World Health Organization. Report on global sexually transmitted infection surveillance 2013. Geneva, 2014."},{"key":"2025081305110704000_93.8.599.17","unstructured":"World Health Organization. Baseline report on global sexually transmitted infection surveillance 2012. Geneva, 2013."},{"key":"2025081305110704000_93.8.599.18","unstructured":"World Health Organization. A tool for strengthening STI surveillance at the country level. Geneva, 2015."},{"key":"2025081305110704000_93.8.599.19","unstructured":"UNAIDS. Global AIDS response progress reporting 2015\u2014guidance. Geneva, 2014."},{"key":"2025081305110704000_93.8.599.20","unstructured":"Korenromp EL , Mahian\u00e9 G , Nagelkerke N , et al . eds. The Spectrum model estimating national syphilis and gonorrhea prevalence & trends: results for 10 low- and middle-income countries, and implications for strengthening STI surveillance. 17th IUSTI World Congress; 9\u201312 May 2016; Marrakech."},{"key":"2025081305110704000_93.8.599.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61728-0"},{"key":"2025081305110704000_93.8.599.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60696-6"},{"issue":"1","key":"2025081305110704000_93.8.599.23","first-page":"S10","article-title":"Improving global estimates of syphilis in pregnancy by diagnostic test type: a systematic review and meta-analysis","volume":"130","author":"Ham","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"2025081305110704000_93.8.599.24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001396"},{"key":"2025081305110704000_93.8.599.25","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.3428"},{"key":"2025081305110704000_93.8.599.26","unstructured":"Minist\u00e8re de la Sant\u00e9 du Maroc. Surveillance sentinelle du VIH et de la syphilis. Rabat, 2005 \u20132012."},{"key":"2025081305110704000_93.8.599.27","doi-asserted-by":"publisher","DOI":"10.1136\/sti.79.2.98"},{"issue":"2","key":"2025081305110704000_93.8.599.28","first-page":"S81","article-title":"Sexually transmitted disease and HIV prevalence and risk factors in concentrated and generalized HIV epidemic settings","volume":"21","author":"NIMH Collaborative HIV\/STD Prevention Trial Group","year":"2007","journal-title":"AIDS"},{"key":"2025081305110704000_93.8.599.29","unstructured":"World Population Prospects: the 2015 revision [database on the internet]. 2015. http:\/\/esa.un.org\/unpd\/wpp\/"},{"key":"2025081305110704000_93.8.599.30","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000362"},{"key":"2025081305110704000_93.8.599.31","unstructured":"Kouyoumjian SP , Haddad P , El Rhilani H , et al . National and Souss Massa Draa HIV modes of transmission analysis in Morocco 2013. Rabat: Kingdom of Morocco Ministry of Health Department of Epidemiology and Disease Control National STI\/AIDS Programme, Weill Cornell Medical College in Qatar, Qatar Foundation, ONUSIDA, 2014."},{"key":"2025081305110704000_93.8.599.32","unstructured":"Minist\u00e8re de la sant\u00e9 du Maroc. Integrated behavioral and biological surveillance survey among female sex workers in Agadir, Fes, Rabat and Tanger, Morocco, 2010\u20132011. Rabat, 2012."},{"key":"2025081305110704000_93.8.599.33","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2012-050844"},{"key":"2025081305110704000_93.8.599.34","doi-asserted-by":"crossref","first-page":"e525","DOI":"10.1016\/S2214-109X(16)30135-8","article-title":"Declines in maternal and congenital syphilis in 2008 and 2012: a health systems modelling study","volume":"4","author":"Wijesooriya","year":"2016","journal-title":"Lancet Glob Health"},{"key":"2025081305110704000_93.8.599.35","unstructured":"Minist\u00e8re de la sant\u00e9 du Maroc. Etude sur les comportements, attitudes et pratiques des jeunes en mati\u00e8re de VIH-sida. Rabat, 2007."},{"key":"2025081305110704000_93.8.599.36","unstructured":"Minist\u00e8re de la sant\u00e9 du Maroc. Etude sur les comportements, attitudes et pratiques des jeunes en mati\u00e8re de VIH-sida. Rabat, 2013."},{"key":"2025081305110704000_93.8.599.37","doi-asserted-by":"publisher","DOI":"10.1177\/0956462413477971"},{"key":"2025081305110704000_93.8.599.38","unstructured":"Ryan A , Manhart L . Les maladies sexuellement transmissibles au Maroc, pr\u00e9valence des infections, \u00e9valuation de risque et arbre de d\u00e9cision de traitement. Rapport final. AIDSCAP Universit\u00e9 de Washington, 1997."},{"key":"2025081305110704000_93.8.599.39","doi-asserted-by":"publisher","DOI":"10.1136\/sti.74.2.95"},{"key":"2025081305110704000_93.8.599.40","unstructured":"Royaume du Maroc Programme National de lutte contre les IST\/SIDA Direction de l\u2019\u00e9pid\u00e9miologie et des luttes contres les maladies du minist\u00e8re de la sant\u00e9. Etude de pr\u00e9valence des IST chez les femmes qui consultent pour pertes vaginales et\/ou douleurs du bas ventre. Rabat, 2008."},{"key":"2025081305110704000_93.8.599.41","unstructured":"Zimbabwe Ministry of Health. Global AIDS Response Report 2016, Zimbabwe country report, reporting period January 2015-December 2015. Harare, 2016."},{"key":"2025081305110704000_93.8.599.42","unstructured":"Zimbabwe National AIDS Council. Annual report 2015, Coordinating The National Response to HIV and AIDS in Zimbabwe. Harare, 2016."},{"key":"2025081305110704000_93.8.599.43","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2005.016014"},{"key":"2025081305110704000_93.8.599.44","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2010.044933"},{"key":"2025081305110704000_93.8.599.45","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.epidem.2014.06.001","article-title":"Could there have been substantial declines in sexual risk behavior across sub-Saharan Africa in the mid-1990s?","volume":"8","author":"Awad","year":"2014","journal-title":"Epidemics"},{"key":"2025081305110704000_93.8.599.46","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq055"},{"key":"2025081305110704000_93.8.599.47","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-7125(16)30484-9"},{"issue":"1","key":"2025081305110704000_93.8.599.48","doi-asserted-by":"crossref","first-page":"i55","DOI":"10.1136\/sti.78.suppl_1.i55","article-title":"The effect of HIV, behavioural change, and STD syndromic management on STD epidemiology in sub-Saharan Africa: simulations of Uganda","volume":"78","author":"Korenromp","year":"2002","journal-title":"Sex Transm Infect"},{"key":"2025081305110704000_93.8.599.49","doi-asserted-by":"publisher","DOI":"10.1086\/425274"},{"key":"2025081305110704000_93.8.599.50","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2013-051166"},{"key":"2025081305110704000_93.8.599.51","unstructured":"Rietmeijer KC , ed. The aetiology of STI syndromes in Zimbabwe. 17th IUSTI World Congress; May 2016; Marrakech. Marrakech, 2016."},{"key":"2025081305110704000_93.8.599.52","unstructured":"Minist\u00e8re de la Sant\u00e9 du Maroc. Estimations Nationales VIH \/sida 2016: Rapport National 2016 sur la Mise en oeuvre de la declaration politique sur le VIH\/SID. Rabat, 2016."},{"key":"2025081305110704000_93.8.599.53","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2012-050918"},{"key":"2025081305110704000_93.8.599.54","unstructured":"Johnston LG . Integrated behavioral and biological surveillance survey among men who have sex with men (MSM) in Agadir and Marrakech, 2010\u20132011. Rabat: Kingdom of Morocco Ministry of Health and National STI\/AIDS Programme, Joint United Nations Programme on HIV\/AIDS, Global Fund, 2011."},{"key":"2025081305110704000_93.8.599.55","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000291"},{"key":"2025081305110704000_93.8.599.56","doi-asserted-by":"publisher","DOI":"10.1053\/j.spid.2005.06.006"},{"issue":"4","key":"2025081305110704000_93.8.599.57","doi-asserted-by":"crossref","first-page":"S461","DOI":"10.1097\/QAD.0000000000000459","article-title":"Redefining the HIV epidemic in Nigeria: from national to state level","volume":"28","author":"Mahy","year":"2014","journal-title":"AIDS"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2016-052953","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T12:12:16Z","timestamp":1755087136000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2016-052953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,21]]},"references-count":57,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2017,11,24]]},"published-print":{"date-parts":[[2017,12]]}},"alternative-id":["10.1136\/sextrans-2016-052953"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2016-052953","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,21]]}}}