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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
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Official URL: https://doi.org/10.1093/trstmh/try062
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 | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine | ||||||
| Divisions: | Faculty of Science > Life Sciences (2010- ) Faculty of Science > Mathematics |
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| 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: |
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| 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 | ||||||
| RIOXX Funder/Project Grant: |
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