Social network analysis identified central outcomes for core outcome sets using systematic reviews of HIV/AIDS

Abstract

Objective Methods to develop core outcome sets, the minimum outcomes that should be measured in research in a topic area, vary. We applied social network analysis methods to understand outcome co-occurrence patterns in HIV/AIDS systematic reviews, and identify outcomes central to the network of outcomes in HIV/AIDS. Study Design and Setting We examined all Cochrane reviews of HIV/AIDS as of June 2013. We defined a tie as two outcomes (nodes) co-occurring in ≥2 reviews. To identify central outcomes, we used normalized node betweenness centrality (nNBC) (the extent to which connections between other outcomes in a network rely on that outcome as an intermediary). We conducted a subgroup analysis by HIV/AIDS intervention type (i.e., clinical management, biomedical prevention, behavioral prevention, and health services). Results The 140 included reviews examined 1140 outcomes, 294 of which were unique. The most central outcome overall was all-cause mortality (nNBC=23.9). The most central and most frequent outcomes differed overall and within subgroups. For example, ‘adverse events (specified)’ was among the most central but not among the most frequent outcomes, overall. Conclusion Social network analysis methods are a novel application to identify central outcomes, which provides additional information potentially useful for developing core outcome sets.

Clinical trials and systematic reviews addressing similar interventions for the same condition do not consider similar outcomes to be important: a case study in HIV/AIDS

“…Our current study of trials and our previous study of reviews in HIV/AIDS [14] have documented a large variety of outcomes used in this field. Abundance of outcomes is not a problem in and of itself; disease conditions such as HIV/AIDS involve various body organs, giving rise to multifaceted clinical presentations that can be managed with numerous possible interventions.…”

“…In addition, where the primary purpose of the trial is regulatory approval, certain outcomes such as adherence become particularly useful [21]. Results from reviews, on the other hand, may more often directly inform evidence-based clinical practice guidelines and healthcare policy, and may be less constrained by considerations that trialists generally have [5,14]. Future research, such as qualitative studies, should explore this issue further.…”

“…We previously described our methods abstracting information about the outcomes named in Cochrane reviews on HIV/AIDS [14]. For the current study, we were interested in examining the overlap in outcomes between the reviews and the trials that the reviews included; we therefore restricted our sample to those HIV/AIDS reviews that were completed (i.e., we excluded protocols) and included at least one trial (i.e., we excluded “empty” reviews).…”

“…We pilot tested the form using 10 trials, and revised it as appropriate. The form included check-box items for pre-defined outcomes identified in our previous study [14], as well as free-text items where data abstractors could enter additional outcomes not previously identified. Two individuals (IJS and a Cochrane systematic review methodologist, Ms. Sueko Ng) independently extracted information about all reported outcomes.…”

“…Since the epidemic began, AIDS-related illnesses have claimed approximately 35 million lives, 1.1 million of which were lost in 2015 [13]. A large number of HIV/AIDS trials and reviews have been conducted, and these have examined a variety of relevant interventions and outcomes [14]. …”