Targeting the Use of Pooled HIV RNA Screening to Reduce Cost in Health Department STD Clinics: New York City, 2009–2011

Borges, Christine; Pathela, Preeti; Pirillo, Robert E.; Blank, Susan

doi:10.1177/003335491513000110

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…Furthermore, targeting resources to specific subpopulations of MSM (e.g. those reporting high‐risk behaviour and/or symptoms) can substantially reduce costs compared with universal AEHI testing [36].…”

Section: Discussionmentioning

confidence: 99%

“…Modelling and phylogenetic transmission studies suggest that 10% to 50% of HIV transmission events occur during AEHI [8,31‐35]. In order to reduce HIV incidence among MSM, screening strategies should target MSM with the highest risk behaviour, as AEHI yield will be the highest [36]. Ideally, all people at risk of HIV acquisition should be tested for AEHI.…”

Section: Introductionmentioning

confidence: 99%

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Acute and early HIV infection screening among men who have sex with men, a systematic review and meta‐analysis

Palmer

Dijkstra

Ket

et al. 2020

J. Intern. AIDS Soc.

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Introduction: Screening for acute and early HIV infections (AEHI) among men who have sex with men (MSM) remains uncommon in sub-Saharan Africa (SSA). Yet, undiagnosed AEHI among MSM and subsequent failure to link to care are important drivers of the HIV epidemic. We conducted a systematic review and meta-analysis of AEHI yield among MSM mobilized for AEHI testing; and assessed which risk factors and/or symptoms could increase AEHI yield in MSM. Methods: We systematically searched four databases from their inception through May 2020 for studies reporting strategies of mobilizing MSM for testing and their AEHI yield, or risk and/or symptom scores targeting AEHI screening. AEHI yield was defined as the proportion of AEHI cases among the total number of visits. Study estimates for AEHI yield were pooled using random effects models. Predictive ability of risk and/or symptom scores was expressed as the area under the receiver operator curve (AUC). Results: Twenty-two studies were identified and included a variety of mobilization strategies (eight studies) and risk and/or symptom scores (fourteen studies). The overall pooled AEHI yield was 6.3% (95% CI, 2.1 to 12.4; I 2 = 94.9%; five studies); yield varied between studies using targeted strategies (11.1%; 95% CI, 5.9 to 17.6; I 2 = 83.8%; three studies) versus universal testing (1.6%; 95% CI, 0.8 to 2.4; two studies). The AUC of risk and/or symptom scores ranged from 0.69 to 0.89 in development study samples, and from 0.51 to 0.88 in validation study samples. AUC was the highest for scores including symptoms, such as diarrhoea, fever and fatigue. Key risk score variables were age, number of sexual partners, condomless receptive anal intercourse, sexual intercourse with a person living with HIV, a sexually transmitted infection, and illicit drug use. No studies were identified that assessed AEHI yield among MSM in SSA and risk and/or symptom scores developed among MSM in SSA lacked validation. Conclusions: Strategies mobilizing MSM for targeted AEHI testing resulted in substantially higher AEHI yields than universal AEHI testing. Targeted AEHI testing may be optimized using risk and/or symptom scores, especially if scores include symptoms. Studies assessing AEHI yield and validation of risk and/or symptom scores among MSM in SSA are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute and early HIV infection screening among men who have sex with men, a systematic review and meta‐analysis

Palmer

Dijkstra

Ket

et al. 2020

J. Intern. AIDS Soc.

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“…Prevalence estimation based on individual assays is also costly. Pooling or group testing can substantially reduce the cost 7‐12 . Pooling was originally used during World War II for efficiently screening military inductees for syphilis 13 .…”

Section: Introductionmentioning

confidence: 99%

Survival analysis under the Cox proportional hazards model with pooled covariates

Saha‐Chaudhuri

Juwara

2020

Statistics in Medicine

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For a continuous time‐to‐event outcome and an expensive‐to‐measure exposure, we develop a pooling design and propose a likelihood‐based approach to estimate the hazard ratios (HRs) of a Cox proportional hazards (PH) model. Our proposed approach fits a PH model based on pooled exposures with individually observed time‐to‐event outcomes. The design and estimation exploits the equivalence of the conditional logistic likelihood functions arising from a matched case‐control study and the partial likelihood function of a riskset‐matched, nested case‐control (NCC) subset of a cohort study. To create the pools, we first focus on an NCC subcohort. Pools are formed at random while keeping the matching intact. Pool‐level exposure and confounders are then evaluated and used in the likelihood to estimate the HR and the standard error of the estimates. The estimators are MLEs, provide consistent estimates of the individual‐level HRs, and are asymptotically normal. Our simulation results indicate that the pooled estimates are comparable to the estimates obtained from the NCC subcohort. The units of analysis for the pooled design are the pools and not the individual participants. Hence the effective sample size is reduced. Therefore, the variance of the HR estimate increases with increasing poolsize. However, this variance inflation in small samples can be offset by including more matched controls per case within the NCC subcohort. An application is demonstrated with the Second Manifestations of ARTerial disease (SMART) study.

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“…This approach has been established but still requires phlebotomy, which makes it unsuitable for many typical HVCT settings. [14][15][16] Many studies have demonstrated that dried blood spots (DBS) are useful for infant HIV diagnosis and monitoring plasma HIV viral loads with an excellent analytical performance. [17][18][19] However, no data is available for a DBS testing pooling strategy to diagnose acute and early adult HIV infections.…”

Section: Introductionmentioning

confidence: 99%

HIV-1 RNA testing of pooled dried blood spots is feasible to diagnose acute HIV infection in resource limited settings

Dowling

Veldsman

Katusiime

et al. 2017

Southern African Journal of Infectious Diseases

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Targeting the Use of Pooled HIV RNA Screening to Reduce Cost in Health Department STD Clinics: New York City, 2009–2011

Abstract: Targeted screening identified similar numbers of AHI cases as when screening all clinic patients seeking HIV testing, but at one-seventh the cost.

Cited by 9 publications

References 20 publications

Acute and early HIV infection screening among men who have sex with men, a systematic review and meta‐analysis

Acute and early HIV infection screening among men who have sex with men, a systematic review and meta‐analysis

Survival analysis under the Cox proportional hazards model with pooled covariates

HIV-1 RNA testing of pooled dried blood spots is feasible to diagnose acute HIV infection in resource limited settings

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