Diagnosing risk factors alongside mass drug administration using serial diagnostic tests-which test first?
Trans R Soc Trop Med Hyg
; 112(7): 342-348, 2018 07 01.
Article
en En
| MEDLINE
| ID: mdl-30020529
Background: When tests are used in series to determine individual risk factors and infection status in a mass drug administration (MDA), the diagnostics, test order and subsequent treatment decisions (the testing algorithm) affect population-level treatment coverage and cost, but there is no existing framework for evaluating which algorithm optimizes any given outcome. Methods: We present a mathematical tool (with spreadsheet implementation) to analyse the effect of test ordering, illustrated using treatment for onchocerciasis in an area where high-burden Loa loa co-infections present a known risk factor. Results: The prevalence of the infection and risk factor have a non-linear impact on the optimal ordering of tests. Testing for the MDA infection first always leaves more infected people untreated but fewer people with the risk factor being misclassified. The cost of the treatment given to infected individuals with the risk factor does not affect which algorithm is more cost effective. Conclusions: For a given test and treat algorithm and its costs, the correct strategy depends on the expected prevalence. In most cases, when the apparent prevalence of the target infection is greater than the apparent prevalence of the risk factor, it is cheaper to do the risk factor test first, and vice versa.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Oncocercosis
/
Loiasis
/
Análisis Costo-Beneficio
/
Toma de Decisiones
/
Pruebas Diagnósticas de Rutina
/
Coinfección
/
Administración Masiva de Medicamentos
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Animals
/
Female
/
Humans
/
Pregnancy
Idioma:
En
Revista:
Trans R Soc Trop Med Hyg
Año:
2018
Tipo del documento:
Article
Pais de publicación:
Reino Unido