A coarsened multinomial regression model for perinatal mother to child transmission of HIV
نویسندگان
چکیده
BACKGROUND In trials designed to estimate rates of perinatal mother to child transmission of HIV, HIV assays are scheduled at multiple points in time. Still, infection status for some infants at some time points may be unknown, particularly when interim analyses are conducted. METHODS Logistic regression models are commonly used to estimate covariate-adjusted transmission rates, but their methods for handling missing data may be inadequate. Here we propose using coarsened multinomial regression models to estimate cumulative and conditional rates of HIV transmission. Through simulation, we compare the proposed models to standard logistic models in terms of bias, mean squared error, coverage probability, and power. We consider a range of treatment effect and visit process scenarios, while including imperfect sensitivity of the assay and contamination of the endpoint due to early breastfeeding transmission. We illustrate the approach through analysis of data from a clinical trial designed to prevent perinatal transmission. RESULTS The proposed cumulative and conditional models performed well when compared to their logistic counterparts. Performance of the proposed cumulative model was particularly strong under scenarios where treatment was assumed to increase the risk of in utero transmission but decrease the risk of intrapartum and overall perinatal transmission and under scenarios designed to represent interim analyses. Power to estimate intrapartum and perinatal transmission was consistently higher for the proposed models. CONCLUSION Coarsened multinomial regression models are preferred to standard logistic models for estimation of perinatal mother to child transmission of HIV, particularly when assays are missing or occur off-schedule for some infants.
منابع مشابه
Prevention of Mother to Child HIV Transmission
In Iran 8% of HIV- infected cases are women. Since most of them are young and in childbearing ages, in case of becoming pregnant and not receiving preventive measures, they can infect their child. Without Preventive measures transmission rate is 15 to 45 percent. Several factors such as sever stage of HIV and AIDS ,CD4 low count, high viral loud, acute retroviral phase, STDs, vaginal delivery, ...
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عنوان ژورنال:
- BMC Medical Research Methodology
دوره 8 شماره
صفحات -
تاریخ انتشار 2008