Optimal allocation of gold standard testing under constrained availability: application to assessment of HIV treatment failure

DOI10.1080/01621459.2013.810149MaRDI QIDQ5406342zbMATH OpenOpenAlexWikidataFDO

Authors Tao Liu, Joseph W. Hogan, Lisa Wang, Shangxuan Zhang, Rami Kantor

Publication date 1 April 2014

Published in Journal of the American Statistical Association (Search for Journal in Brave)

Full work available at URL https://arxiv.org/abs/2010.00692, http://europepmc.org/articles/pmc3963362

zbMATH Keywords

constrained optimizationROCHIV/AIDSresource limitedantiretroviral failuretripartite classification

Mathematics Subject Classification ID

Applications of statistics to biology and medical sciences; meta analysis (62P10) Medical applications (general) (92C50) Testing in survival analysis and censored data (62N03)

Abstract: The World Health Organization (WHO) guidelines for monitoring the effectiveness of HIV treatment in resource-limited settings (RLS) are mostly based on clinical and immunological markers (e.g., CD4 cell counts). Recent research indicates that the guidelines are inadequate and can result in high error rates. Viral load (VL) is considered the "gold standard", yet its widespread use is limited by cost and infrastructure. In this paper, we propose a diagnostic algorithm that uses information from routinely-collected clinical and immunological markers to guide a selective use of VL testing for diagnosing HIV treatment failure, under the assumption that VL testing is available only at a certain portion of patient visits. Our algorithm identifies the patient subpopulation, such that the use of limited VL testing on them minimizes a pre-defined risk (e.g., misdiagnosis error rate). Diagnostic properties of our proposal algorithm are assessed by simulations. For illustration, data from the Miriam Hospital Immunology Clinic (RI, USA) are analyzed.

Recommendations

• Optimal test allocation
• Design of viral dynamic studies for efficiently assessing potency of anti-HIV therapies in AIDS clinical trials
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• Bayesian Methods for Predicting Interacting Protein Pairs Using Domain Information
• ``Markov control with rate state observation: sensitivity analysis with respect to optimal treatment strategies against HIV-1

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Cited in

(1)

• Screening with Cost-Effective Quality Control: Potential Applications to HIV and Drug Testing

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• ElemStatLearn

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