1
|
Nance N, Petersen ML, van der Laan M, Balzer LB. The Causal Roadmap and Simulations to Improve the Rigor and Reproducibility of Real-data Applications. Epidemiology 2024; 35:00001648-990000000-00284. [PMID: 39087681 PMCID: PMC11444352 DOI: 10.1097/ede.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
The Causal Roadmap outlines a systematic approach to asking and answering questions of cause and effect: define the quantity of interest, evaluate needed assumptions, conduct statistical estimation, and carefully interpret results. To protect research integrity, it is essential that the algorithm for statistical estimation and inference be prespecified prior to conducting any effectiveness analyses. However, it is often unclear which algorithm will perform optimally for the real-data application. Instead, there is a temptation to simply implement one's favorite algorithm, recycling prior code or relying on the default settings of a computing package. Here, we call for the use of simulations that realistically reflect the application, including key characteristics such as strong confounding and dependent or missing outcomes, to objectively compare candidate estimators and facilitate full specification of the statistical analysis plan. Such simulations are informed by the Causal Roadmap and conducted after data collection but prior to effect estimation. We illustrate with two worked examples. First, in an observational longitudinal study, we use outcome-blind simulations to inform nuisance parameter estimation and variance estimation for longitudinal targeted minimum loss-based estimation. Second, in a cluster randomized trial with missing outcomes, we use treatment-blind simulations to examine type-I error control in two-stage targeted minimum loss-based estimation. In both examples, realistic simulations empower us to prespecify an estimation approach that is expected to have strong finite sample performance and also yield quality-controlled computing code for the actual analysis. Together, this process helps to improve the rigor and reproducibility of our research.
Collapse
Affiliation(s)
- Nerissa Nance
- From the University of California, Berkeley, Berkeley, CA
| | | | | | | |
Collapse
|
2
|
Marquez C, Atukunda M, Nugent J, Charlebois ED, Chamie G, Mwangwa F, Ssemmondo E, Kironde J, Kabami J, Owaraganise A, Kakande E, Ssekaynzi B, Abbott R, Ayieko J, Ruel T, Kwariisima D, Kamya M, Petersen M, Havlir DV, Balzer LB. Community-Wide Universal HIV Test and Treat Intervention Reduces Tuberculosis Transmission in Rural Uganda: A Cluster-Randomized Trial. Clin Infect Dis 2024; 78:1601-1607. [PMID: 38226445 PMCID: PMC11175690 DOI: 10.1093/cid/ciad776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) treatment reduces tuberculosis (TB) disease and mortality; however, the population-level impact of universal HIV-test-and-treat interventions on TB infection and transmission remain unclear. METHODS In a sub-study nested in the SEARCH trial, a community cluster-randomized trial (NCT01864603), we assessed whether a universal HIV-test-and-treat intervention reduced population-level incident TB infection in rural Uganda. Intervention communities received annual, population-level HIV testing and patient-centered linkage. Control communities received population-level HIV testing at baseline and endline. We compared estimated incident TB infection by arms, defined by tuberculin skin test conversion in a cohort of persons aged 5 and older, adjusting for participation and predictors of infection, and accounting for clustering. RESULTS Of the 32 trial communities, 9 were included, comprising 90 801 participants (43 127 intervention and 47 674 control). One-year cumulative incidence of TB infection was 16% in the intervention and 22% in the control; SEARCH reduced the population-level risk of incident TB infection by 27% (adjusted risk ratio = 0.73; 95% confidence interval [CI]: .57-.92, P = .005). In pre-specified analyses, the effect was largest among children aged 5-11 years and males. CONCLUSIONS A universal HIV-test-and-treat intervention reduced incident TB infection, a marker of population-level TB transmission. Investments in community-level HIV interventions have broader population-level benefits, including TB reductions.
Collapse
Affiliation(s)
- Carina Marquez
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | | | - Joshua Nugent
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Edwin D Charlebois
- Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, California, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | | | | | - Joel Kironde
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Bob Ssekaynzi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Rachel Abbott
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - James Ayieko
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Theodore Ruel
- Department of Pediatrics, University of California, San Francisco, California, USA
| | | | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- School of Medicine, Makerere University, Kampala, Uganda
| | - Maya Petersen
- Division of Biostatistics, School of Public Health University of California, Berkeley, California, USA
| | - Diane V Havlir
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Laura B Balzer
- Division of Biostatistics, School of Public Health University of California, Berkeley, California, USA
| |
Collapse
|
3
|
Abbott R, Landsiedel K, Atukunda M, Puryear SB, Chamie G, Hahn JA, Mwangwa F, Kakande E, Petersen ML, Havlir DV, Charlebois E, Balzer LB, Kamya MR, Marquez C. Incident Tuberculosis Infection is Associated with Alcohol use in Adults in Rural Uganda. Clin Infect Dis 2024:ciae304. [PMID: 38824440 DOI: 10.1093/cid/ciae304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/23/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024] Open
Abstract
Data on alcohol use and incident Tuberculosis (TB) infection are needed. In adults aged 15+ in rural Uganda (N=49,585), estimated risk of incident TB infection was 29.2% with alcohol use vs. 19.2% without (RR: 1.49; 95%CI: 1.40-1.60). There is potential for interventions to interrupt transmission among people who drink alcohol.
Collapse
Affiliation(s)
- Rachel Abbott
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, CA, USA
| | | | | | - Sarah B Puryear
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, CA, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, CA, USA
| | - Judith A Hahn
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, CA, USA
| | | | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Diane V Havlir
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, CA, USA
| | - Edwin Charlebois
- Center for AIDS Prevention, University of California San Francisco, CA, USA
| | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Carina Marquez
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, CA, USA
| |
Collapse
|