Impact of economic constraints on a Chlamydia trachomatis screening program

Abstract: Mathematical and computational models are one of several tools which can be employed by policy makers interested in determining the impact of screening on the control of infectious diseases. Current models focus on quantifying prevalence reduction as a result of screening programs; how to best structure a screening program under a limited budget remains an open question. Here we use optimal control theory, a mathematical optimization technique, to investigate how a screening program can be implemented to minimize the economic costs of chlamydia infections when a screening program is in place. Applying this technique to the National Chlamydia Screening Program (NCSP) in the UK, we consider two different but entirely plausible minimization goals which lead to dramatically different screening strategies. Using numerical results, we obtain estimates of optimal yearly screening rates, budget costs, and the expected decrease in chlamydia prevalence. Our methods allow us to estimate the budget needed to fund an optimal screening strategy, to determine how the screening program will change according to desired public health outcomes, and to indicate how to best allocate a pre-determined budget. We conclude by considering the implications of our study to the NCSP and other screening programs.