Optimal allocation of gold standard testing under constrained availability: Application to assessment of HIV treatment failure Journal Article


Authors: Liu, T.; Hogan, J. W.; Wang, L.; Zhang, S.; Kantor, R.
Article Title: Optimal allocation of gold standard testing under constrained availability: Application to assessment of HIV treatment failure
Abstract: The World Health Organization (WHO) guidelines for monitoring the effectiveness of human immunodeficiency virus (HIV) treatment in resource-limited settings are mostly based on clinical and immunological markers (e.g., CD4 cell counts). Recent research indicates that the guidelines are inadequate and can result in high error rates. Viral load (VL) is considered the "gold standard," yet its widespread use is limited by cost and infrastructure. In this article, we propose a diagnostic algorithm that uses information from routinely collected clinical and immunological markers to guide a selective use of VL testing for diagnosing HIV treatment failure, under the assumption that VL testing is available only at a certain portion of patient visits. Our algorithm identifies the patient subpopulation, such that the use of limited VL testing on them minimizes a predefined risk (e.g., misdiagnosis error rate). Diagnostic properties of our proposed algorithm are assessed by simulations. For illustration, data from the Miriam Hospital Immunology Clinic (Providence, RI) are analyzed. © 2013 American Statistical Association.
Keywords: roc; hiv/aids; constrained optimization; antiretroviral failure; tripartite classification; resource limited
Journal Title: Journal of the American Statistical Association
Volume: 108
Issue: 504
ISSN: 0162-1459
Publisher: American Statistical Association  
Date Published: 2013-12-01
Start Page: 1173
End Page: 1188
Language: English
DOI: 10.1080/01621459.2013.810149
PROVIDER: scopus
PMCID: PMC3963362
PUBMED: 24672142
DOI/URL:
Notes: J. Am. Stat. Assoc. -- Export Date: 8 July 2014 -- Source: Scopus
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  1. Shangxuan   Zhang
    1 Zhang