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Diagnosing risk factors alongside mass drug administration using serial diagnostic tests - which test first?

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Dyson, Louise and Hollingsworth, T. Déirdre (2018) Diagnosing risk factors alongside mass drug administration using serial diagnostic tests - which test first? Transactions of the Royal Society of Tropical Medicine and Hygiene, 112 (7). pp. 342-348. doi:10.1093/trstmh/try062 ISSN 0035-9203.

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Official URL: https://doi.org/10.1093/trstmh/try062

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Abstract

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 coinfections present a known risk factor.

Results

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.

Conclusion

For a given test and treat algorithm and its costs, the correct strategy depends on 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.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- )
Faculty of Science, Engineering and Medicine > Science > Mathematics
Library of Congress Subject Headings (LCSH): Onchocerciasis -- Treatment, Vector control
Journal or Publication Title: Transactions of the Royal Society of Tropical Medicine and Hygiene
Publisher: Elsevier Ltd
ISSN: 0035-9203
Official Date: 18 July 2018
Dates:
DateEvent
18 July 2018Published
2 July 2018Accepted
Volume: 112
Number: 7
Page Range: pp. 342-348
DOI: 10.1093/trstmh/try062
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access
Date of first compliant deposit: 11 June 2018
Date of first compliant Open Access: 3 August 2018
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDBill and Melinda Gates Foundationhttp://dx.doi.org/10.13039/100000865

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