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Evaluation Of Progress Towards The Unaids 90-90-90 Hiv Care Cascade: A Description Of Statistical Methods Used In An Interim Analysis Of The Intervention Communities In The Search Study, Laura Balzer, Joshua Schwab, Mark J. Van Der Laan, Maya L. Petersen Feb 2017

Evaluation Of Progress Towards The Unaids 90-90-90 Hiv Care Cascade: A Description Of Statistical Methods Used In An Interim Analysis Of The Intervention Communities In The Search Study, Laura Balzer, Joshua Schwab, Mark J. Van Der Laan, Maya L. Petersen

Laura B. Balzer

WHO guidelines call for universal antiretroviral treatment, and UNAIDS has set a global target to virally suppress most HIV-positive individuals. Accurate estimates of population-level coverage at each step of the HIV care cascade (testing, treatment, and viral suppression) are needed to assess the effectiveness of "test and treat" strategies implemented to achieve this goal. The data available to inform such estimates, however, are susceptible to informative missingness: the number of HIV-positive individuals in a population is unknown; individuals tested for HIV may not be representative of those whom a testing intervention fails to reach, and HIV-positive individuals with a viral …


Using A Network-Based Approach And Targeted Maximum Likelihood Estimation To Evaluate The Effect Of Adding Pre-Exposure Prophylaxis To An Ongoing Test-And-Treat Trial, Laura Balzer, Patrick Staples, Jukka-Pekka Onnela, Victor De Gruttola Jan 2017

Using A Network-Based Approach And Targeted Maximum Likelihood Estimation To Evaluate The Effect Of Adding Pre-Exposure Prophylaxis To An Ongoing Test-And-Treat Trial, Laura Balzer, Patrick Staples, Jukka-Pekka Onnela, Victor De Gruttola

Laura B. Balzer

Background: Several cluster randomized trials are underway to investigate the implementation and effectiveness of a universal test-and-treat strategy on the HIV epidemic in sub-Saharan Africa. We consider nesting studies of pre-exposure prophylaxis (PrEP) within these trials. PrEP is a general strategy where high risk HIV- persons take antiretrovirals daily to reduce their risk of infection from exposure to HIV. We address how to target PrEP to high risk groups and how to maximize power to detect the individual and combined effects of universal test-and-treat and PrEP strategies.
Methods: We simulated 1000 trials, each consisting of 32 villages with 200 individuals …