Optimization of Case Definitions for Sensitivity as a Preventive Strategy—A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission

In clinical studies, case definitions are usually designed to optimally match the desired clinical state, because lacking specificity is associated with a risk of bias regarding the study outcome. In preventive medicine, however, high sensitivity is sometimes considered as more critical in order not...

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Autores principales:	Andreas Hahn, Hagen Frickmann, Ulrike Loderstädt
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	rapid diagnostic testing RDT sensitivity modelling symptoms transmission prevention Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/c06075aa122e4b46be237e27e27ec411
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spelling	oai:doaj.org-article:c06075aa122e4b46be237e27e27ec4112021-11-25T17:21:26ZOptimization of Case Definitions for Sensitivity as a Preventive Strategy—A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission10.3390/diagnostics111120792075-4418https://doaj.org/article/c06075aa122e4b46be237e27e27ec4112021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4418/11/11/2079https://doaj.org/toc/2075-4418In clinical studies, case definitions are usually designed to optimally match the desired clinical state, because lacking specificity is associated with a risk of bias regarding the study outcome. In preventive medicine, however, high sensitivity is sometimes considered as more critical in order not to overlook infectious individuals, because the latter may be associated with ongoing spread of a transmittable disease. Accordingly, this work was focused on a theoretical model on how the sensitivity of case definitions can be optimized by adding clinical symptoms to diagnostic results for preventive purposes, if the associated reduction in specificity is considered as acceptable. The model was exemplified with an analysis on whether and in how far exposure risk can be reduced by the inclusion of observable symptoms during seroconversion syndrome in case of rapid diagnostic test-based prevention of sexual HIV transmission. The approach provided a high level of safety (negative predictive values close to 1) for the price of a considerably number of false positives (positive predictive values < 0.01 for some subpopulations). When applying such a sensitivity-optimized screening as a “diagnostics as prevention” strategy, the advantages of excellent negative predictive values need to be cautiously balanced against potential undesirable consequences of low positive predictive values.Andreas HahnHagen FrickmannUlrike LoderstädtMDPI AGarticlerapid diagnostic testingRDTsensitivitymodellingsymptomstransmission preventionMedicine (General)R5-920ENDiagnostics, Vol 11, Iss 2079, p 2079 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	rapid diagnostic testing RDT sensitivity modelling symptoms transmission prevention Medicine (General) R5-920
spellingShingle	rapid diagnostic testing RDT sensitivity modelling symptoms transmission prevention Medicine (General) R5-920 Andreas Hahn Hagen Frickmann Ulrike Loderstädt Optimization of Case Definitions for Sensitivity as a Preventive Strategy—A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission
description	In clinical studies, case definitions are usually designed to optimally match the desired clinical state, because lacking specificity is associated with a risk of bias regarding the study outcome. In preventive medicine, however, high sensitivity is sometimes considered as more critical in order not to overlook infectious individuals, because the latter may be associated with ongoing spread of a transmittable disease. Accordingly, this work was focused on a theoretical model on how the sensitivity of case definitions can be optimized by adding clinical symptoms to diagnostic results for preventive purposes, if the associated reduction in specificity is considered as acceptable. The model was exemplified with an analysis on whether and in how far exposure risk can be reduced by the inclusion of observable symptoms during seroconversion syndrome in case of rapid diagnostic test-based prevention of sexual HIV transmission. The approach provided a high level of safety (negative predictive values close to 1) for the price of a considerably number of false positives (positive predictive values < 0.01 for some subpopulations). When applying such a sensitivity-optimized screening as a “diagnostics as prevention” strategy, the advantages of excellent negative predictive values need to be cautiously balanced against potential undesirable consequences of low positive predictive values.
format	article
author	Andreas Hahn Hagen Frickmann Ulrike Loderstädt
author_facet	Andreas Hahn Hagen Frickmann Ulrike Loderstädt
author_sort	Andreas Hahn
title	Optimization of Case Definitions for Sensitivity as a Preventive Strategy—A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission
title_short	Optimization of Case Definitions for Sensitivity as a Preventive Strategy—A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission
title_full	Optimization of Case Definitions for Sensitivity as a Preventive Strategy—A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission
title_fullStr	Optimization of Case Definitions for Sensitivity as a Preventive Strategy—A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission
title_full_unstemmed	Optimization of Case Definitions for Sensitivity as a Preventive Strategy—A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission
title_sort	optimization of case definitions for sensitivity as a preventive strategy—a modelling exemplified with rapid diagnostic test-based prevention of sexual hiv transmission
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/c06075aa122e4b46be237e27e27ec411
work_keys_str_mv	AT andreashahn optimizationofcasedefinitionsforsensitivityasapreventivestrategyamodellingexemplifiedwithrapiddiagnostictestbasedpreventionofsexualhivtransmission AT hagenfrickmann optimizationofcasedefinitionsforsensitivityasapreventivestrategyamodellingexemplifiedwithrapiddiagnostictestbasedpreventionofsexualhivtransmission AT ulrikeloderstadt optimizationofcasedefinitionsforsensitivityasapreventivestrategyamodellingexemplifiedwithrapiddiagnostictestbasedpreventionofsexualhivtransmission
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Optimization of Case Definitions for Sensitivity as a Preventive Strategy—A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission

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