Diagnosing risk factors alongside mass drug administration using serial diagnostic tests-which test first?
Author(s)
Dyson, Louise
Hollingsworth, T Déirdre
Type
Journal Article
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 co-infections present a known risk factor. Results: The 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. Conclusions: For a given test and treat algorithm and its costs, the correct strategy depends on the 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.
Date Issued
2018-07-18
Date Acceptance
2018-07-02
Citation
Transactions of The Royal Society of Tropical Medicine and Hygiene, 2018, 112 (7), pp.342-348
ISSN
0035-9203
Publisher
Oxford University Press (OUP)
Start Page
342
End Page
348
Journal / Book Title
Transactions of The Royal Society of Tropical Medicine and Hygiene
Volume
112
Issue
7
Copyright Statement
© The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (
http://creativecommons.org/licenses/
by/4.0/
), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (
http://creativecommons.org/licenses/
by/4.0/
), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30020529
PII: 5055444
Subjects
0605 Microbiology
1108 Medical Microbiology
1117 Public Health And Health Services
Tropical Medicine
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-07-18