title: Revised simulation model does not predict rebound in gonorrhoea prevalence where core groups are treated in the presence of antimicrobial resistance.
abstract: OBJECTIVE
  To determine the effects of using discrete versus continuous quantities of people in a compartmental model examining the contribution of antimicrobial resistance (AMR) to rebound in the prevalence of gonorrhoea.
  
  
  METHODS
  A previously published transmission model was reconfigured to represent the occurrence of gonorrhoea in discrete persons, rather than allowing fractions of infected individuals during simulations.
  
  
  RESULTS
  In the revised model, prevalence only rebounded under scenarios reproduced from the original paper when AMR occurrence was increased by 10(5) times. In such situations, treatment of high-risk individuals yielded outcomes very similar to those resulting from treatment of low-risk and intermediate-risk individuals. Otherwise, in contrast with the original model, prevalence was the lowest when the high-risk group was treated, supporting the current policy of targeting treatment to high-risk groups.
  
  
  CONCLUSIONS
  Simulation models can be highly sensitive to structural features. Small differences in structure and parameters can substantially influence predicted outcomes and policy prescriptions, and must be carefully considered.
authors.affiliation: Vaccine and Infectious Disease Organization-International Vaccine Centre, Saskatoon, Saskatchewan, Canada School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Trecker
authors.affiliation: Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Hogan
authors.affiliation: School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Waldner
authors.affiliation: Vaccine and Infectious Disease Organization-International Vaccine Centre, Saskatoon, Saskatchewan, Canada Department of Microbiology and Immunology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Jo-Anne R
authors.initials: JA
authors.lastname: Dillon
authors.affiliation: Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Nathaniel D
authors.initials: ND
authors.lastname: Osgood
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003140:Communicable Disease Control; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D006069:Gonorrhea / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D015233:Models, Statistical; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D015995:Prevalence
chemical_list: D000900:Anti-Bacterial Agents
keywords: ANTIBIOTIC RESISTANCE; ANTIMICROBIAL RESISTANCE; GONORRHOEA; MATHEMATICAL MODEL; NEISSERIA GONORRHOEA