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Peer-reviewedCC BY 4.0The American Journal of Tropical Medicine and Hygiene

Comparison of Methods for Assessing Chlamydia trachomatis Transmission Intensity: A Systematic Review

  • Kristen K. Renneker1,2
  • Che-Chi Lin1
  • Jennifer L. Hsieh3
  • Pamela J. Hooper1
  • Robert Butcher2
  • T. Déirdre Hollingsworth4
  • Diana L. Martin3
  • Anthony W. Solomon5
  • Emma M. Harding-Esch2
5 affiliations
  1. 1International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA
  2. 2Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
  3. 3Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  4. 4Big Data Institute, La Ka Shing Center for Health Informatics, University of Oxford, Oxford, United Kingdom
  5. 5Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
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Abstract

Field-graded trachomatous inflammation–follicular (TF) has limitations as the sole indicator of Chlamydia trachomatis (Ct) transmission for trachoma programmatic decision-making. To assess the relationship between field-graded TF and other methodologies for evaluating Ct transmission intensity, a systematic review was conducted. A total of 35,764 studies were screened, yielding 235 included studies from 49 countries spanning the years of data collection from 1991 to 2021 and the years of publication from 1991 to 2022. The relationship between TF and other indicators was stronger before mass drug administration (MDA) versus after MDA initiation: TF versus infection (R2 = 0.43, P = 0.004 versus R2 = 0.05, P = 0.140, respectively), TF versus seroprevalence (R2 = 0.55, P <0.001 versus R2 = 0.09, P = 0.084, respectively), and TF versus seroconversion rate (SCR; R2 = 0.52, P = 0.012 versus R2 = 0.26, P = 0.061, respectively). Post-MDA initiation, infection and SCR were highly correlated (R2 = 0.71, P = 0.001). These results are strongly suggestive of the poor performance of TF prevalence for guiding programmatic decision-making post-MDA initiation. Infection and/or serology should be considered in these settings.

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Cite

BibTeXRIS
BibTeX
@article{renneker2026comparison,
  title = {{Comparison of Methods for Assessing Chlamydia trachomatis Transmission Intensity: A Systematic Review}},
  author = {Kristen K. Renneker and Che-Chi Lin and Jennifer L. Hsieh and Pamela J. Hooper and Robert Butcher and T. Déirdre Hollingsworth and Diana L. Martin and Anthony W. Solomon and Emma M. Harding-Esch},
  journal = {The American Journal of Tropical Medicine and Hygiene},
  year = {2026},
  month = sep,
  doi = {10.4269/ajtmh.25-0541},
  url = {https://doi.org/10.4269/ajtmh.25-0541},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Comparison of Methods for Assessing Chlamydia trachomatis Transmission Intensity: A Systematic Review
AU  - Kristen K. Renneker
AU  - Che-Chi Lin
AU  - Jennifer L. Hsieh
AU  - Pamela J. Hooper
AU  - Robert Butcher
AU  - T. Déirdre Hollingsworth
AU  - Diana L. Martin
AU  - Anthony W. Solomon
AU  - Emma M. Harding-Esch
PY  - 2026
DA  - 2026/09/22
JO  - The American Journal of Tropical Medicine and Hygiene
DO  - 10.4269/ajtmh.25-0541
UR  - https://doi.org/10.4269/ajtmh.25-0541
AB  - Field-graded trachomatous inflammation–follicular (TF) has limitations as the sole indicator of Chlamydia trachomatis (Ct) transmission for trachoma programmatic decision-making. To assess the relationship between field-graded TF and other methodologies for evaluating Ct transmission intensity, a systematic review was conducted. A total of 35,764 studies were screened, yielding 235 included studies from 49 countries spanning the years of data collection from 1991 to 2021 and the years of publication from 1991 to 2022. The relationship between TF and other indicators was stronger before mass drug administration (MDA) versus after MDA initiation: TF versus infection (R2 = 0.43, P = 0.004 versus R2 = 0.05, P = 0.140, respectively), TF versus seroprevalence (R2 = 0.55, P <0.001 versus R2 = 0.09, P = 0.084, respectively), and TF versus seroconversion rate (SCR; R2 = 0.52, P = 0.012 versus R2 = 0.26, P = 0.061, respectively). Post-MDA initiation, infection and SCR were highly correlated (R2 = 0.71, P = 0.001). These results are strongly suggestive of the poor performance of TF prevalence for guiding programmatic decision-making post-MDA initiation. Infection and/or serology should be considered in these settings.
SN  - 0002-9637
SN  - 1476-1645
ER  -