DOI: 10.1101/19012781Nov 22, 2019Paper

Far from MCAR: obtaining population-level estimates of HIV viral suppression

MedRxiv : the Preprint Server for Health Sciences
Laura BalzerMaya L Petersen

Abstract

Background: Population-level estimates of disease prevalence and control are needed to assess the effectiveness of prevention and treatment strategies. However, available data are often subject to differential missingness. Consider population-level HIV viral suppression: proportion of all HIV-positive persons who are suppressing viral replication. Individuals with measured HIV status, and, among HIV-positive individuals, those with measured viral suppression are likely to differ from those without such measurements. Methods: We discuss three sets of assumptions sufficient to identify population-level suppression over time in the intervention arm of the SEARCH Study (NCT01864603), a community randomized trial in rural Kenya and Uganda (2013-2017). Using data on nearly 100,000 participants, we compare estimates from an unadjusted approach assuming data are missing-completely-at-random (MCAR); stratification on age group, sex, and community; and, targeted maximum likelihood estimation (TMLE) with Super Learner to adjust for baseline and time-updated predictors of measurement. Results: Despite high annual coverage of testing, estimates of population-level viral suppression varied by identification assumption. Unadjusted estimates w...Continue Reading

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