treatall-cd4-vl
Impact of Treat-All policy on CD4 and viral load testing practices in Southern Africa.
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Impact of Treat-All policy on CD4 and viral load testing practices in Southern Africa.
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Metadata Files
README.md
Impact of Treat-All policy on CD4 and viral load testing practices
This repository shares the Stata coding files used to produce the output published in the following:
JCE 2021 manuscript
Zaniewski E, Brazier E, Ostinelli CHD, Wood R, Osler M, et al. Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries. J Clin Epidemiol 2021, 140:101-110. doi: 10.1016/j.jclinepi.2021.09.001
This analysis included HIV cohort data from The International epidemiology Databases to Evaluate AIDS Southern Africa collaboration (https://www.iedea-sa.org), which collects de-identified patient-level data from participating cohorts in Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe.
Methods
We used regression discontinuity design (RDD) methods to determine whether adoption of national Treat-All polices (which occurred in 2016-2017) impacted CD4 and viral load testing practices of antiretroviral therapy (ART) programs in six Southern African countries. We used the date of ART initiation as a continuous eligibility assignment variable. Patients starting ART before Treat-All adoption were considered unexposed and patients starting ART on or after Treat-All adoption were considered exposed.
Do files
All statistical analyses were performed using Stata version 15.1 (Stata Corp., College Station, TX, USA).
Do file prep
Do file combines the viral load (RNA) analysis data to the pre-ART CD4 analysis data and generates several variables used to produce the output included in the following tables and figure.
Do file Table 1
Creates the Table 1 of baseline characteristics for each analysis and combines the output into one table that is exported to MS Excel.
Do file Table 2
Calculates the following output for the pre-ART CD4 analysis by country:
1. Number of patients unexposed and exposed
2. RDD risk difference at the Treat-All threshold
3. TED value
4. Predicted outcome at Treat-All threshold
5. Slope before and after Treat-All
Do file Table 3
Calculates the following output for the pre-ART CD4 analysis by country and sex:
1. Number of patients unexposed and exposed
2. RDD risk difference at the Treat-All threshold
Do file Table 4
Calculates the following output for the viral load monitoring analysis by country:
1. Number of patients unexposed and exposed
2. RDD risk difference at the Treat-All threshold
3. TED value
4. Predicted outcome at Treat-All threshold
5. Slope before and after Treat-All
Do file Table 5
Calculates the following output for the viral load monitoring analysis by country and sex:
1. Number of patients unexposed and exposed
2. RDD risk difference at the Treat-All threshold
Do file Figure 1
Creates and combines plots for each country that illustrate the:
1. Monthly mean percentage with pre-ART CD4 testing or viral load monitoring
2. Linear prediction produced by the regression discontinuity models using the IK bandwidths
3. 95% confidence intervals
4. Number of patients included in each analysis
License
© 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license. https://creativecommons.org/licenses/by/4.0/
Owner
- Name: Elizabeth (Zaniewski) Rahn
- Login: bethrahn128
- Kind: user
- Location: Minnesota
- Repositories: 1
- Profile: https://github.com/bethrahn128
Citation (CITATION.bib)
@article{ZANIEWSKI2021101,
title = {Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries},
journal = {Journal of Clinical Epidemiology},
volume = {140},
pages = {101-110},
year = {2021},
issn = {0895-4356},
doi = {https://doi.org/10.1016/j.jclinepi.2021.09.001},
url = {https://www.sciencedirect.com/science/article/pii/S089543562100281X},
author = {Elizabeth Zaniewski and Ellen Brazier and Cam Ha Dao Ostinelli and Robin Wood and Meg Osler and Karl-Günter Technau and Joep J {van Oosterhout} and Nicola Maxwell and Janneke {van Dijk} and Hans Prozesky and Matthew P Fox and Jacob Bor and Denis Nash and Matthias Egger},
keywords = {CD4 lymphocyte count, Viral load, Antiretroviral therapy, Southern Africa, HIV infection, Regression discontinuity design},
abstract = {Objective
To determine whether Treat-All policy impacted laboratory testing practices of antiretroviral therapy (ART) programs in Southern Africa.
Study Design and Setting
We used HIV cohort data from Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe in a regression discontinuity design to estimate changes in pre-ART CD4 testing and viral load monitoring following national Treat-all adoption that occurred during 2016 to 2017. This study included more than 230,000 ART-naïve people living with HIV (PLHIV) aged five years or older who started ART within two years of national Treat-All adoption.
Results
We found pre-ART CD4 testing decreased following adoption of Treat-All recommendations in Malawi (-21.4 percentage points (pp), 95% confidence interval, CI: -26.8, -16.0) and in Mozambique (-8.8pp, 95% CI: -14.9, -2.8), but increased in Zambia (+2.7pp, 95% CI: +0.4, +5.1). Treat-All policy had no effect on viral load monitoring, except among females in South Africa (+7.1pp, 95% CI: +1.1, +13.0).
Conclusion
Treat-All policy expanded ART eligibility, but led to reductions in pre-ART CD4 testing in some countries that may weaken advanced HIV disease management. Continued and expanded support of CD4 and viral load laboratory capacity is needed to further improve treatment successes and allow for uniform evaluation of ART implementation across Southern Africa.}
}