Diagnosing risk factors alongside mass drug administration using serial diagnostic tests—which test first?
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 existin...
| Main Authors: | , |
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| Format: | Journal article |
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Oxford University Press
2018
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| _version_ | 1797087029152972800 |
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| author | Dyson, L Hollingsworth, T |
| author_facet | Dyson, L Hollingsworth, T |
| author_sort | Dyson, L |
| collection | OXFORD |
| description | 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. |
| first_indexed | 2024-03-07T02:30:20Z |
| format | Journal article |
| id | oxford-uuid:a704c8f8-47c8-4872-b194-8b42f1079591 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T02:30:20Z |
| publishDate | 2018 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:a704c8f8-47c8-4872-b194-8b42f10795912022-03-27T02:51:34ZDiagnosing risk factors alongside mass drug administration using serial diagnostic tests—which test first?Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a704c8f8-47c8-4872-b194-8b42f1079591Symplectic Elements at OxfordOxford University Press2018Dyson, LHollingsworth, TBackground 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. |
| spellingShingle | Dyson, L Hollingsworth, T Diagnosing risk factors alongside mass drug administration using serial diagnostic tests—which test first? |
| title | Diagnosing risk factors alongside mass drug administration using serial diagnostic tests—which test first? |
| title_full | Diagnosing risk factors alongside mass drug administration using serial diagnostic tests—which test first? |
| title_fullStr | Diagnosing risk factors alongside mass drug administration using serial diagnostic tests—which test first? |
| title_full_unstemmed | Diagnosing risk factors alongside mass drug administration using serial diagnostic tests—which test first? |
| title_short | Diagnosing risk factors alongside mass drug administration using serial diagnostic tests—which test first? |
| title_sort | diagnosing risk factors alongside mass drug administration using serial diagnostic tests which test first |
| work_keys_str_mv | AT dysonl diagnosingriskfactorsalongsidemassdrugadministrationusingserialdiagnostictestswhichtestfirst AT hollingswortht diagnosingriskfactorsalongsidemassdrugadministrationusingserialdiagnostictestswhichtestfirst |