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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
mathematics
Emulating a trial of joint dynamic strategies: An application to monitoring and treatment of HIV-positive individuals
Statistics in Medicine, Volume 38, No. 13, Year 2019
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Description
Decisions about when to start or switch a therapy often depend on the frequency with which individuals are monitored or tested. For example, the optimal time to switch antiretroviral therapy depends on the frequency with which HIV-positive individuals have HIV RNA measured. This paper describes an approach to use observational data for the comparison of joint monitoring and treatment strategies and applies the method to a clinically relevant question in HIV research: when can monitoring frequency be decreased and when should individuals switch from a first-line treatment regimen to a new regimen?. We outline the target trial that would compare the dynamic strategies of interest and then describe how to emulate it using data from HIV-positive individuals included in the HIV-CAUSAL Collaboration and the Centers for AIDS Research Network of Integrated Clinical Systems. When, as in our example, few individuals follow the dynamic strategies of interest over long periods of follow-up, we describe how to leverage an additional assumption: no direct effect of monitoring on the outcome of interest. We compare our results with and without the “no direct effect” assumption. We found little differences on survival and AIDS-free survival between strategies where monitoring frequency was decreased at a CD4 threshold of 350 cells/μl compared with 500 cells/μl and where treatment was switched at an HIV-RNA threshold of 1000 copies/ml compared with 200 copies/ml. The “no direct effect” assumption resulted in efficiency improvements for the risk difference estimates ranging from an 7- to 53-fold increase in the effective sample size. © 2019 John Wiley & Sons, Ltd.
Authors & Co-Authors
Caniglia, Ellen C.
United States, Boston
Harvard T.h. Chan School of Public Health
United States, New York
New York University
Robins, James M.
United States, Boston
Harvard T.h. Chan School of Public Health
Cain, Lauren E.
United States, Boston
Harvard T.h. Chan School of Public Health
Sabin, Caroline Anne
United Kingdom, London
University College London
Logan, Roger W.
United States, Boston
Harvard T.h. Chan School of Public Health
Abgrall, Sophie
France, Bobigny
Hopital Avicenne
Mugavero, Michael J.
United States, Birmingham
The University of Alabama at Birmingham
Hernández-Díaz, Sonia
United States, Boston
Harvard T.h. Chan School of Public Health
Meyer, Laurence J.
France, Gif-sur-yvette
Université Paris-saclay
Seng, Rémonie
France, Gif-sur-yvette
Université Paris-saclay
Drozd, Daniel R.
United States, Seattle
University of Washington
Seage, George R.
United States, Boston
Harvard T.h. Chan School of Public Health
Bonnet, Fabrice
France, Talence
Centre Hospitalier Universitaire de Bordeaux
Moore, Richard D.
United States, Baltimore
Johns Hopkins University
Reiss, Peter
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
van Sighem, Ard I.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Mathews, William Christopher
United States, La Jolla
University of California, San Diego
Jarrín, Inma
Spain, Madrid
Instituto de Salud Carlos Iii
Alejos, Belén
Spain, Madrid
Instituto de Salud Carlos Iii
Deeks, Steven G.
United States, San Francisco
University of California, San Francisco
Muga, Roberto
Spain, Badalona
Hospital Universitari Germans Trias I Pujol
Boswell, Stephen L.
United States, Boston
Fenway Community Health Center
Ferrer, Elena V.
Spain, Barcelona
Hospital Universitari de Bellvitge
Eron, Joseph J.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Gill, M. John
Unknown Affiliation
Pacheco, A. G.
Brazil, Rio de Janeiro
Fundacao Oswaldo Cruz
Grinsztejn, Beatriz Gilda Jegerhorn
Brazil, Rio de Janeiro
Fundacao Oswaldo Cruz
Napravnik, Sonia
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Jose, Sophie
United Kingdom, London
University College London
Phillips, Andrew N.
United Kingdom, London
University College London
Justice, Amy C.
United States, New Haven
Yale University
Tate, Janet P.
United States, New Haven
Yale University
Bucher, Heíner C.C.
Switzerland, Basel
Universitätsspital Basel
Egger, Matthias
Switzerland, Bern
University of Bern
Furrer, Hansjakob Jackob
Switzerland, Bern
University of Bern
Miró, José María ª.
Spain, Barcelona
Universitat de Barcelona
Casabona, Jordi
Spain, Hospitalet de Llobregat
Institute Catala Oncologia
Porter, Kholoud
United Kingdom, London
University College London
Touloumi, Giota
Greece, Athens
School of Medicine
Crane, Heidi M.
United States, Seattle
University of Washington
Costagliola, Dominique
France, Paris
Sorbonne Université
Saag, Michael S.
United States, Birmingham
The University of Alabama at Birmingham
Hernán, Miguel A.
United States, Boston
Harvard T.h. Chan School of Public Health
United States, Cambridge
Harvard-mit Health Sciences and Technology
Statistics
Citations: 15
Authors: 43
Affiliations: 26
Identifiers
Doi:
10.1002/sim.8120
ISSN:
02776715
Research Areas
Infectious Diseases
Study Design
Cohort Study