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Zrubka Z, Champion A, Holtorf AP, Di Bidino R, Earla JR, Boltyenkov AT, Tabata-Kelly M, Asche C, Burrell A. The PICOTS-ComTeC Framework for Defining Digital Health Interventions: An ISPOR Special Interest Group Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:383-396. [PMID: 38569772 DOI: 10.1016/j.jval.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Digital health definitions are abundant, but often lack clarity and precision. We aimed to develop a minimum information framework to define patient-facing digital health interventions (DHIs) for outcomes research. METHODS Definitions of digital-health-related terms (DHTs) were systematically reviewed, followed by a content analysis using frameworks, including PICOTS (population, intervention, comparator, outcome, timing, and setting), Shannon-Weaver Model of Communication, Agency for Healthcare Research and Quality Measures, and the World Health Organization's Classification of Digital Health Interventions. Subsequently, we conducted an online Delphi study to establish a minimum information framework, which was pilot tested by 5 experts using hypothetical examples. RESULTS After screening 2610 records and 545 full-text articles, we identified 101 unique definitions of 67 secondary DHTs in 76 articles, resulting in 95 different patterns of concepts among the definitions. World Health Organization system (84.5%), message (75.7%), intervention (58.3%), and technology (52.4%) were the most frequently covered concepts. For the Delphi survey, we invited 47 members of the ISPOR Digital Health Special Interest Group, 18 of whom became the Delphi panel. The first, second, and third survey rounds were completed by 18, 11, and 10 respondents, respectively. After consolidating results, the PICOTS-ComTeC acronym emerged, involving 9 domains (population, intervention, comparator, outcome, timing, setting, communication, technology, and context) and 32 optional subcategories. CONCLUSIONS Patient-facing DHIs can be specified using PICOTS-ComTeC that facilitates identification of appropriate interventions and comparators for a given decision. PICOTS-ComTeC is a flexible and versatile tool, intended to assist authors in designing and reporting primary studies and evidence syntheses, yielding actionable results for clinicians and other decision makers.
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Affiliation(s)
- Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary.
| | | | | | - Rossella Di Bidino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; The Graduate School of Health Economics and Management (ALTEMS), Rome, Italy
| | | | | | - Masami Tabata-Kelly
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Carl Asche
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt-Lake City, UT, USA
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Laktabai J, Kimachas E, Kipkoech J, Menya D, Arthur D, Zhou Y, Chepkwony T, Abel L, Robie E, Amunga M, Ambani G, Woldeghebriel M, Garber E, Eze N, Mudabai P, Gallis JA, Fashanu C, Saran I, Woolsey A, Visser T, Turner EL, Prudhomme O’Meara W. A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002451. [PMID: 38324584 PMCID: PMC10849268 DOI: 10.1371/journal.pgph.0002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
ACTs are responsible for a substantial proportion of the global reduction in malaria mortality over the last ten years, made possible by publicly-funded subsidies making these drugs accessible and affordable in the private sector. However, inexpensive ACTs available in retail outlets have contributed substantially to overconsumption. We test an innovative, scalable strategy to target ACT-subsidies to clients with a confirmatory diagnosis. We supported malaria testing(mRDTs) in 39 medicine outlets in western Kenya, randomized to three study arms; control arm offering subsidized mRDT testing (0.4USD), client-directed intervention where all clients who received a positive RDT at the outlet were eligible for a free (fully-subsidized) ACT, and a combined client and provider directed intervention where clients with a positive RDT were eligible for free ACT and outlets received 0.1USD for every RDT performed. Our primary outcome was the proportion of ACT dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients tested at the outlet and adherence to diagnostic test results. 43% of clients chose to test at the outlet. Test results informed treatment decisions, resulting in targeting of ACTs to confirmed malaria cases- 25.3% of test-negative clients purchased an ACT compared to 75% of untested clients. Client-directed and client+provider-directed interventions did not offer further improvements, compared to the control arm, in testing rates(RD = 0.09, 95%CI:-0.08,0.26) or dispensing of ACTs to test-positive clients(RD = 0.01,95% CI:-0.14, 0.16). Clients were often unaware of the price they paid for the ACT leading to uncertainty in whether the ACT subsidy was passed on to the client. This uncertainty undermines our ability to definitively conclude that client-directed subsidies are not effective for improving testing and appropriate treatment. We conclude that mRDTs could reduce ACT overconsumption in the private retail sector, but incentive structures are difficult to scale and their value to private providers is uncertain. Trial registration: ClinicalTrials.gov NCT04428307.
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Affiliation(s)
- Jeremiah Laktabai
- Moi University School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Emmah Kimachas
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - Joseph Kipkoech
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - Diana Menya
- Moi University School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - David Arthur
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Yunji Zhou
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | | | - Lucy Abel
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - Emily Robie
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Mark Amunga
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - George Ambani
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | | | | | - Nwamaka Eze
- Clinton Health Access Initiative (CHAI), Lagos, Nigeria
| | | | - John A. Gallis
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | - Indrani Saran
- School of Social Work, Boston College, Newton, Massachusetts, United States of America
| | - Aaron Woolsey
- Clinton Health Access Initiative (CHAI), Boston, Massachusetts, United States of America
| | - Theodoor Visser
- Clinton Health Access Initiative (CHAI), Boston, Massachusetts, United States of America
| | - Elizabeth L. Turner
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Wendy Prudhomme O’Meara
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya
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Visser T, Laktabai J, Kimachas E, Kipkoech J, Menya D, Arthur D, Zhou Y, Chepkwony T, Abel L, Robie E, Amunga M, Ambani G, Uhomoibhi P, Ogbulafor N, Oshinowo B, Ogunsola O, Woldeghebriel M, Garber E, Olaleye T, Eze N, Nwidae L, Mudabai P, Gallis J, Fashanu C, Saran I, Woolsey A, Turner E, Prudhomme O’Meara W. A cluster-randomized trial of client and provider directed financial interventions to align incentives with appropriate case management in private medicine retailers: results of the TESTsmART Trial in Lagos, Nigeria. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.30.24302026. [PMID: 38352390 PMCID: PMC10862997 DOI: 10.1101/2024.01.30.24302026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Malaria remains a major health priority in Nigeria. Among children with fever who seek care, less than a quarter gets tested for malaria, leading to inappropriate use of the recommended treatment for malaria; Artemether Combination Therapies (ACT). Here we test an innovative strategy to target ACT subsidies to clients seeking care in Nigeria's private retail health sector who have a confirmed malaria diagnosis. We supported point-of-care malaria testing (mRDTs) in 48 Private Medicine Retailers (PMRs) in the city of Lagos, Nigeria and randomized them to two study arms; a control arm offering subsidized mRDT testing for USD $0.66, and an intervention arm where, in addition to access to subsidized testing as in the control arm, clients who received a positive mRDT at the PMR were eligible for a free (fully subsidized) first-line ACT and PMRs received USD $0.2 for every mRDT performed. Our primary outcome was the proportion of ACTs dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients who were tested at the PMR and adherence to diagnostic test results. Overall, 23% of clients chose to test at the PMR. Test results seemed to inform treatment decisions and resulted in enhanced targeting of ACTs to confirmed malaria cases with only 26% of test-negative clients purchasing an ACT compared to 58% of untested clients. However, the intervention did not offer further improvements, compared to the control arm, in testing rates or dispensing of ACTs to test-positive clients. We found that ACT subsidies were not passed on to clients testing positive in the intervention arm. We conclude that RDTs could reduce ACT overconsumption in Nigeria's private retail health sector, but PMR-oriented incentive structures are difficult to implement and may need to be complemented with interventions targeting clients of PMRs to increase test uptake and adherence. Clinical Trials Registration Number: NCT04428307.
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Affiliation(s)
- T. Visser
- Clinton Health Access Initiative (CHAI), Boston, Massachusetts, United States of America
| | - J. Laktabai
- Moi University School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - E. Kimachas
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - J. Kipkoech
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - D. Menya
- Moi University School of Public Health, College of Health Sciences, Moi University, Kenya
| | - D. Arthur
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Y. Zhou
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - T. Chepkwony
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - L. Abel
- Moi University School of Public Health, College of Health Sciences, Moi University, Kenya
| | - E. Robie
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - M. Amunga
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - G. Ambani
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - P. Uhomoibhi
- National Malaria Elimination Program, Federal Ministry of Health & Social Welfare, Abuja, Nigeria
| | - N. Ogbulafor
- National Malaria Elimination Program, Federal Ministry of Health & Social Welfare, Abuja, Nigeria
| | - B. Oshinowo
- Lagos State Malaria Elimination Program, Lagos State Ministry of Health, Lagos, Nigeria
| | - O. Ogunsola
- Simon Business School, University of Rochester, Rochester, New York, United States of America
| | | | - E. Garber
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - T. Olaleye
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - N. Eze
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - L. Nwidae
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - P. Mudabai
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - J.A. Gallis
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - C. Fashanu
- Clinton Health Access Initiative (CHAI), Abuja, Nigeria
| | - I. Saran
- School of Social Work, Boston College, Massachusetts, United States of America
| | - A. Woolsey
- Clinton Health Access Initiative (CHAI), Boston, Massachusetts, United States of America
| | - E.L. Turner
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - W. Prudhomme O’Meara
- Duke Global Health Institute and Moi University School of Public Health, College of Health Science
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Odhiambo FO, O'Meara WP, Abade A, Owiny M, Odhiambo F, Oyugi EO. Adherence to national malaria treatment guidelines in private drug outlets: a cross-sectional survey in the malaria-endemic Kisumu County, Kenya. Malar J 2023; 22:307. [PMID: 37821868 PMCID: PMC10568760 DOI: 10.1186/s12936-023-04744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Malaria prevalence in Kenya is 6%, with a three-fold higher prevalence in western Kenya. Adherence to malaria treatment guidelines improves care for suspected malaria cases and can reduce unnecessary anti-malarial use. Data on adherence to guidelines in retail drug outlets (DOs) is limited, yet approximately 50% of people with fever access treatment first in these outlets. This study assessed adherence to the national malaria treatment guidelines among DOs in a high transmission area of Western Kenya. METHODS In a cross-sectional survey of DOs in Kisumu Central and Seme sub-counties in 2021, DO staff were interviewed using structured questionnaires to assess outlet characteristics (location, testing services), staff demographics (age, sex, training), and health system context (supervision, inspection). Mystery shoppers (research assistants disguised as clients) observed malaria management practices and recorded observations on a standardized tool. Adherence was defined as dispensing artemether-lumefantrine (AL) to patients with a confirmed positive test, accompanied by appropriate medication counseling. Logistic regression was used to test for association between adherence to guidelines and DO-related factors. RESULTS None of the 70 DOs assessed had a copy of the guidelines, and 60 (85.7%) were in an urban setting. Staff adhered to the guidelines in 14 (20%) outlets. The odds of adherence were higher among staff who had a bachelor's degree {odds ratio (OR) 6.0, 95% confidence interval (95% CI) 1.66-21.74}, those trained on malaria rapid diagnostic test (RDT) {OR 4.4, 95% CI 1.29-15.04}, and those who asked about patient's symptoms {OR 3.6, 95% CI 1.08-12.25}. DOs that had higher odds of adherence included those with functional thermometers {OR 5.3, 95% CI 1.46-19.14}, those recently inspected (within three months) by Pharmacy and Poisons Board (PPB) {OR 9.4, 95% CI 2.55-34.67}, and those with all basic infrastructure {OR 3.9, 95% CI 1.01-15.00}. On logistic regression analysis, recent PPB inspection {adjusted OR (AOR) 4.6, 95% CI 1.03-20.77} and malaria RDT-trained staff (aOR 4.5, 95% CI 1.02-19.84) were independently associated with adherence. CONCLUSION Most outlets didn't adhere to malaria guidelines. Regular interaction with regulatory bodies could improve adherence. Ministry of Health should enhance private sector engagement and train DOs on RDT use.
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Affiliation(s)
| | - Wendy P O'Meara
- School of Public Health, Moi University, Eldoret, Kenya
- Duke Global Health Institute, Durham, NC, USA
| | - Ahmed Abade
- Field Epidemiology and Laboratory Training Programme, Nairobi, Kenya
| | - Maurice Owiny
- Field Epidemiology and Laboratory Training Programme, Nairobi, Kenya
| | - Fredrick Odhiambo
- Field Epidemiology and Laboratory Training Programme, Nairobi, Kenya
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5
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Laktabai J, Kimachas E, Kipkoech J, Menya D, Arthur D, Zhou Y, Chepkwony T, Abel L, Robie E, Amunga M, Ambani G, Woldeghebriel M, Garber E, Eze N, Mudabai P, Gallis JA, Fashanu C, Saran I, Woolsey A, Visser T, Turner EL, O'Meara WP. A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: results of the TESTsmART Trial in western Kenya. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.14.23295586. [PMID: 37745516 PMCID: PMC10516073 DOI: 10.1101/2023.09.14.23295586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
ACTs are responsible for a substantial proportion of the global reduction in malaria mortality over the last ten years. These reductions would not have been possible without publicly-funded subsidies making these drugs accessible and affordable in the private sector. However, inexpensive ACTs available in retail outlets have contributed substantially to their overconsumption. We test an innovative, scalable, and sustainable strategy to target ACT subsidies to clients with a confirmatory diagnosis. We supported point-of-care malaria testing (mRDTs) in 39 retail medicine outlets in western Kenya and randomized them to three study arms; control arm offering subsidized RDT testing for 0.4USD, client-directed intervention where all clients who received a positive RDT at the outlet were eligible for a free (fully subsidized) first-line ACT, and a combined client and provider directed intervention where clients with a positive RDT were eligible for free ACT and outlets received 0.1USD for every RDT performed. Our primary outcome was the proportion of ACT dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients tested at the outlet and adherence to diagnostic test results. 43% of clients chose to test at the outlet. Test results informed treatment decisions and resulted in targeting of ACTs to confirmed malaria cases - 25.3% of test-negative clients purchased an ACT compared to 75% of untested clients. Client-directed and client+provider-directed interventions did not offer further improvements, compared to the control arm, in testing rates (RD=0.09, 95%CI:-0.08,0.26) or dispensing of ACTs to test-positive clients (RD=0.01,95% CI: -0.14, 0.16). Clients were often unaware of the price they paid for the ACT leading to uncertainty in whether the ACT subsidy was passed on to the client. We conclude that mRDTs could reduce ACT overconsumption in the private retail sector, but incentive structures are difficult to scale and their value to private providers is uncertain.
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Affiliation(s)
- J Laktabai
- Moi University School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - E Kimachas
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - J Kipkoech
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - D Menya
- Moi University School of Public Health, College of Health Sciences, Moi University
| | - D Arthur
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC
| | - Y Zhou
- Department of Biostatistics, University of Washington, Seattle WA
| | - T Chepkwony
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - L Abel
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - E Robie
- Duke Global Health Institute
| | - M Amunga
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - G Ambani
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | | | - E Garber
- Clinton Health Access Initiative (CHAI) Nigeria
| | - Nwamaka Eze
- Clinton Health Access Initiative (CHAI) Nigeria
| | | | - J A Gallis
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC
| | | | - I Saran
- School of Social Work, Boston College
| | - A Woolsey
- Clinton Health Access Initiative (CHAI) Boston, Massachusetts
| | - T Visser
- Clinton Health Access Initiative (CHAI) Boston, Massachusetts
| | - E L Turner
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC
| | - W Prudhomme O'Meara
- Duke Global Health Institute and Moi University School of Public Health, College of Health Science
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6
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Woolsey AM, Simmons RA, Woldeghebriel M, Zhou Y, Ogunsola O, Laing S, Olaleye T, Kipkoech J, Rojas BM, Saran I, Odhiambo M, Malinga J, Ambani G, Kimachas E, Fashanu C, Wiwa O, Menya D, Laktabai J, Visser T, Turner EL, O’Meara WP. Correction: Incentivizing appropriate malaria case management in the private sector: a study protocol for two linked cluster randomized controlled trials to evaluate provider- and client-focused interventions in western Kenya and Lagos, Nigeria. Implement Sci 2022; 17:61. [PMID: 36109753 PMCID: PMC9476591 DOI: 10.1186/s13012-022-01233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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7
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Cohen JM, Okumu F, Moonen B. The fight against malaria: Diminishing gains and growing challenges. Sci Transl Med 2022; 14:eabn3256. [PMID: 35767649 DOI: 10.1126/scitranslmed.abn3256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Since the year 2000, historic reductions in malaria incidence and mortality have been driven by the widespread distribution of bed nets, drugs, and insecticides for the prevention and treatment of malaria. Scale-up of these tools has been enabled by an increase in malaria financing compounded by price reductions, yet these trends are unlikely to continue at the same rate. Rapid population growth in high-endemic areas requires procurement of more of these tools just to maintain current coverage, even as prices are likely to increase as resistance to drugs and insecticides forces shifts to newer products. Further progress toward the long-term goal of malaria eradication requires a combination of greater funding, more cost-effective resource allocation, and fundamental changes to the global malaria control strategy.
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Affiliation(s)
| | - Fredros Okumu
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.,School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Bruno Moonen
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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8
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Zhou Y, Turner EL, Simmons RA, Li F. Constrained randomization and statistical inference for multi‐arm parallel cluster randomized controlled trials. Stat Med 2022; 41:1862-1883. [PMID: 35146788 PMCID: PMC9007899 DOI: 10.1002/sim.9333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 12/17/2022]
Abstract
A practical limitation of cluster randomized controlled trials (cRCTs) is that the number of available clusters may be small, resulting in an increased risk of baseline imbalance under simple randomization. Constrained randomization overcomes this issue by restricting the allocation to a subset of randomization schemes where sufficient overall covariate balance across comparison arms is achieved. However, for multi-arm cRCTs, several design and analysis issues pertaining to constrained randomization have not been fully investigated. Motivated by an ongoing multi-arm cRCT, we elaborate the method of constrained randomization and provide a comprehensive evaluation of the statistical properties of model-based and randomization-based tests under both simple and constrained randomization designs in multi-arm cRCTs, with varying combinations of design and analysis-based covariate adjustment strategies. In particular, as randomization-based tests have not been extensively studied in multi-arm cRCTs, we additionally develop most-powerful randomization tests under the linear mixed model framework for our comparisons. Our results indicate that under constrained randomization, both model-based and randomization-based analyses could gain power while preserving nominal type I error rate, given proper analysis-based adjustment for the baseline covariates. Randomization-based analyses, however, are more robust against violations of distributional assumptions. The choice of balance metrics and candidate set sizes and their implications on the testing of the pairwise and global hypotheses are also discussed. Finally, we caution against the design and analysis of multi-arm cRCTs with an extremely small number of clusters, due to insufficient degrees of freedom and the tendency to obtain an overly restricted randomization space.
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Affiliation(s)
- Yunji Zhou
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
- Duke Global Health Institute Duke University Durham North Carolina USA
| | - Elizabeth L. Turner
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
- Duke Global Health Institute Duke University Durham North Carolina USA
| | - Ryan A. Simmons
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
- Duke Global Health Institute Duke University Durham North Carolina USA
| | - Fan Li
- Department of Biostatistics Yale School of Public Health New Haven Connecticut USA
- Center for Methods in Implementation and Prevention Science Yale School of Public Health New Haven Connecticut USA
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9
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Woolsey AM, Simmons RA, Woldeghebriel M, Zhou Y, Ogunsola O, Laing S, Olaleye T, Kipkoech J, Rojas BM, Saran I, Odhiambo M, Malinga J, Ambani G, Kimachas E, Fashanu C, Wiwa O, Menya D, Laktabai J, Visser T, Turner EL, O'Meara WP. Correction to: Incentivizing appropriate malaria case management in the private sector: a study protocol for two linked cluster randomized controlled trials to evaluate provider- and client-focused interventions in western Kenya and Lagos, Nigeria. Implement Sci 2021; 16:27. [PMID: 33726771 PMCID: PMC7962375 DOI: 10.1186/s13012-021-01093-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
| | - Ryan A Simmons
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Yunji Zhou
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Sarah Laing
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Tayo Olaleye
- Clinton Health Access Initiative, Lagos, Nigeria
| | - Joseph Kipkoech
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya
| | | | - Indrani Saran
- School of Social Work, Boston College, Boston, MA, USA
| | | | | | - George Ambani
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya
| | - Emmah Kimachas
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya
| | | | - Owens Wiwa
- Clinton Health Access Initiative, Abuja, Nigeria
| | - Diana Menya
- College of Health Sciences, Moi University School of Public Health, Eldoret, Kenya
| | - Jeremiah Laktabai
- Academic Model Providing Access to Healthcare, Moi University, Eldoret, Kenya.,College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya
| | | | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Wendy Prudhomme O'Meara
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,College of Health Sciences, Moi University School of Public Health, Eldoret, Kenya. .,Department of Medicine, Duke University, Durham, NC, USA.
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