Incorporating retesting outcomes for estimation of disease prevalence

Using group testing in a two-phase epidemiologic design to identify the effects of a large number of antibody reactions on disease risk

BACKGROUND

The role of immunological responses to exposed bacteria on disease incidence is increasingly under investigation. With many bacterial species, and many potential antibody reactions to a particular species, the large number of assays required for this type of discovery can make it prohibitively expensive. We propose a two-phase group testing design to more efficiently screen numerous antibody effects in a case-control setting.

METHODS

Phase 1 uses group testing to select antibodies that are differentially expressed between cases and controls. The selected antibodies go on to Phase 2 individual testing.

RESULTS

We evaluate the two-phase group testing design through simulations and example data and find that it substantially reduces the number of assays required relative to standard case-control and group testing designs, while maintaining similar statistical properties.

CONCLUSION

The proposed two-phase group testing design can dramatically reduce the number of assays required, while providing comparable results to a case-control design.

Nested Group Testing Procedure

We investigated the false-negative, true-negative, false-positive, and true-positive predictive values from a general group testing procedure for a heterogeneous population. We show that its false (true)-negative predictive value of a specimen is larger (smaller), and the false (true)-positive predictive value is smaller (larger) than that from individual testing procedure, where the former is in aversion. Then we propose a nested group testing procedure, and show that it can keep the sterling characteristics and also improve the false-negative predictive values for a specimen, not larger than that from individual testing. These characteristics are studied from both theoretical and numerical points of view. The nested group testing procedure is better than individual testing on both false-positive and false-negative predictive values, while retains the efficiency as a basic characteristic of a group testing procedure. Applications to Dorfman's, Halving and Sterrett procedures are discussed. Results from extensive simulation studies and an application to malaria infection in microscopy-negative Malawian women exemplify the findings.

Optimizing Pooled Testing for Estimating the Prevalence of Multiple Diseases

Pooled testing can enhance the efficiency of diagnosing individuals with diseases of low prevalence. Often, pooling is implemented using standard groupings (2, 5, 10, etc.). On the other hand, optimization theory can provide specific guidelines in finding the ideal pool size and pooling strategy. This article focuses on optimizing the precision of disease prevalence estimators calculated from multiplex pooled testing data. In the context of a surveillance application of animal diseases, we study the estimation efficiency (i.e., precision) and cost efficiency of the estimators with adjustments for the number of expended tests. This enables us to determine the pooling strategies that offer the highest benefits when jointly estimating the prevalence of multiple diseases, such as theileriosis and anaplasmosis. The outcomes of our work can be used in designing pooled testing protocols, not only in simple pooling scenarios but also in more complex scenarios where individual retesting is performed in order to identify positive cases. A software application using the shiny package in R is provided with this article to facilitate implementation of our methods. Supplementary materials accompanying this paper appear online.

Heterogeneity Aware Two-Stage Group Testing

Group testing refers to the process of testing pooled samples to reduce the total number of tests. Given the current pandemic, and the shortage of test supplies for COVID-19, group testing can play a critical role in time and cost efficient diagnostics. In many scenarios, samples collected from users are also accompanied with auxiliary information (such as demographics, history of exposure, onset of symptoms). Such auxiliary information may differ across patients, and is typically not considered while designing group testing algorithms. In this paper, we abstract such heterogeneity using a model where the population can be categorized into clusters with different prevalence rates. The main result of this work is to show that exploiting knowledge heterogeneity can further improve the efficiency of group testing. Motivated by the practical constraints and diagnostic considerations, we focus on two-stage group testing algorithms, where in the first stage, the goal is to detect as many negative samples by pooling, whereas the second stage involves individual testing to detect any remaining samples. For this class of algorithms, we prove that the gain in efficiency is related to the concavity of the number of tests as a function of the prevalence. We also show how one can choose the optimal pooling parameters for one of the algorithms in this class, namely, doubly constant pooling. We present lower bounds on the average number of tests as a function of the population heterogeneity profile, and also provide numerical results and comparisons.