Factors associated with performing tuberculosis screening of HIV-positive patients in Ghana: LASSO-based predictor selection in a large public health data set
Identifieur interne : 000125 ( Pmc/Curation ); précédent : 000124; suivant : 000126Factors associated with performing tuberculosis screening of HIV-positive patients in Ghana: LASSO-based predictor selection in a large public health data set
Auteurs : Susanne Mueller-Using [Allemagne] ; Torsten Feldt [Allemagne] ; Fred Stephen Sarfo [Ghana] ; Kirsten Alexandra Eberhardt [Allemagne]Source :
- BMC Public Health [ 1471-2458 ] ; 2016.
Abstract
The purpose of this study is to propose the Least Absolute Shrinkage and Selection Operators procedure (LASSO) as an alternative to conventional variable selection models, as it allows for easy interpretation and handles multicollinearities. We developed a model on the basis of LASSO-selected parameters in order to link associated demographical, socio-economical, clinical and immunological factors to performing tuberculosis screening in HIV-positive patients in Ghana.
Applying the LASSO method and multivariate logistic regression analysis on a large public health data set, we selected relevant predictors related to tuberculosis screening.
One Thousand Ninety Five patients infected with HIV were enrolled into this study with 691 (63.2 %) of them having tuberculosis screening documented in their patient folders. Predictors found to be significantly associated with performance of tuberculosis screening can be classified into factors related to the clinician’s perception of the clinical state, as well as those related to PLHIV’s awareness. These factors include newly diagnosed HIV infections (
Accelerated TB screening among newly diagnosed HIV-patients indicates that application of the WHO screening form for intensifying tuberculosis case finding among HIV-positive individuals in resource-limited settings is increasingly adopted. However, screening for TB in PLHIV is still impacted by clinician’s perception of patient’s health state and PLHIV’s health awareness. Education of staff, counselling of PLHIV and sufficient financing are needed for further improvement in implementation of TB screening for all PLHIV. The LASSO approach proved a convenient method for automatic variable selection in a large public health data set that requires efficient and fast algorithms.
ClinicalTrials.gov
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DOI: 10.1186/s12889-016-3239-y
PubMed: 27412114
PubMed Central: 4944423
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Box 1934, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi</wicri:regionArea></affiliation></author><author><name sortKey="Eberhardt, Kirsten Alexandra" sort="Eberhardt, Kirsten Alexandra" uniqKey="Eberhardt K" first="Kirsten Alexandra" last="Eberhardt">Kirsten Alexandra Eberhardt</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359 Hamburg</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The purpose of this study is to propose the Least Absolute Shrinkage and Selection Operators procedure (LASSO) as an alternative to conventional variable selection models, as it allows for easy interpretation and handles multicollinearities. We developed a model on the basis of LASSO-selected parameters in order to link associated demographical, socio-economical, clinical and immunological factors to performing tuberculosis screening in HIV-positive patients in Ghana.</p></sec><sec><title>Methods</title><p>Applying the LASSO method and multivariate logistic regression analysis on a large public health data set, we selected relevant predictors related to tuberculosis screening.</p></sec><sec><title>Results</title><p>One Thousand Ninety Five patients infected with HIV were enrolled into this study with 691 (63.2 %) of them having tuberculosis screening documented in their patient folders. Predictors found to be significantly associated with performance of tuberculosis screening can be classified into factors related to the clinician’s perception of the clinical state, as well as those related to PLHIV’s awareness. These factors include newly diagnosed HIV infections (<italic>n</italic> = 354 (32.42 %), aOR 1.84), current CD4+ T cell count (aOR 0.92), non-availability of HIV type (<italic>n</italic> = 787 (72.07 %), aOR 0.56), chronic cough (<italic>n</italic> = 32 (2.93 %), aOR 5.07), intake of co-trimoxazole (<italic>n</italic> = 271 (24.82 %), aOR 2.31), vitamin supplementation (<italic>n</italic> = 220 (20.15 %), aOR 2.64) as well as the use of mosquito bed nets (<italic>n</italic> = 613 (56.14 %), aOR 1.53).</p></sec><sec><title>Conclusions</title><p>Accelerated TB screening among newly diagnosed HIV-patients indicates that application of the WHO screening form for intensifying tuberculosis case finding among HIV-positive individuals in resource-limited settings is increasingly adopted. However, screening for TB in PLHIV is still impacted by clinician’s perception of patient’s health state and PLHIV’s health awareness. Education of staff, counselling of PLHIV and sufficient financing are needed for further improvement in implementation of TB screening for all PLHIV. The LASSO approach proved a convenient method for automatic variable selection in a large public health data set that requires efficient and fast algorithms.</p></sec><sec><title>Trials registration</title><p>ClinicalTrials.gov <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01897909?term=NCT01897909&rank=1">NCT01897909</ext-link> (July 5, 2013).</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Acharjee, A" uniqKey="Acharjee A">A Acharjee</name></author><author><name sortKey="Finkers, R" uniqKey="Finkers R">R Finkers</name></author><author><name sortKey="Visser, Rg" uniqKey="Visser R">RG Visser</name></author><author><name sortKey="Maliepaard, C" uniqKey="Maliepaard C">C Maliepaard</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Derksen, S" uniqKey="Derksen S">S Derksen</name></author><author><name sortKey="Keselman, H" uniqKey="Keselman H">H 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Public Health</journal-id><journal-id journal-id-type="iso-abbrev">BMC Public Health</journal-id><journal-title-group><journal-title>BMC Public Health</journal-title></journal-title-group><issn pub-type="epub">1471-2458</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27412114</article-id><article-id pub-id-type="pmc">4944423</article-id><article-id pub-id-type="publisher-id">3239</article-id><article-id pub-id-type="doi">10.1186/s12889-016-3239-y</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Factors associated with performing tuberculosis screening of HIV-positive patients in Ghana: LASSO-based predictor selection in a large public health data set</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Mueller-Using</surname><given-names>Susanne</given-names></name><address><email>muellerusing@bnitm.de</email></address><xref ref-type="aff" rid="Aff1"></xref><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Feldt</surname><given-names>Torsten</given-names></name><address><email>torsten.feldt@med.uni-duesseldorf.de</email></address><xref ref-type="aff" rid="Aff1"></xref><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Sarfo</surname><given-names>Fred Stephen</given-names></name><address><email>stephensarfo78@gmail.com</email></address><xref ref-type="aff" rid="Aff4"></xref><xref ref-type="aff" rid="Aff5"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Eberhardt</surname><given-names>Kirsten Alexandra</given-names></name><address><phone>+49 40 42818 290</phone><email>k.eberhardt@bnitm.de</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><label></label>Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359 Hamburg, Germany</aff><aff id="Aff2"><label></label>Hamburg Institute of International Economics, Heimhuder Str. 71, 20148 Hamburg, Germany</aff><aff id="Aff3"><label></label>Clinic of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of the Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany</aff><aff id="Aff4"><label></label>Kwame Nkrumah University of Science and Technology, University Post Office - KNUST, Kumasi, Ghana</aff><aff id="Aff5"><label></label>Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana</aff></contrib-group><pub-date pub-type="epub"><day>13</day><month>7</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>13</day><month>7</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>16</volume><elocation-id>563</elocation-id><history><date date-type="received"><day>10</day><month>12</month><year>2015</year></date><date date-type="accepted"><day>28</day><month>6</month><year>2016</year></date></history><permissions><copyright-statement>© The Author(s). 2016</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>The purpose of this study is to propose the Least Absolute Shrinkage and Selection Operators procedure (LASSO) as an alternative to conventional variable selection models, as it allows for easy interpretation and handles multicollinearities. We developed a model on the basis of LASSO-selected parameters in order to link associated demographical, socio-economical, clinical and immunological factors to performing tuberculosis screening in HIV-positive patients in Ghana.</p></sec><sec><title>Methods</title><p>Applying the LASSO method and multivariate logistic regression analysis on a large public health data set, we selected relevant predictors related to tuberculosis screening.</p></sec><sec><title>Results</title><p>One Thousand Ninety Five patients infected with HIV were enrolled into this study with 691 (63.2 %) of them having tuberculosis screening documented in their patient folders. Predictors found to be significantly associated with performance of tuberculosis screening can be classified into factors related to the clinician’s perception of the clinical state, as well as those related to PLHIV’s awareness. These factors include newly diagnosed HIV infections (<italic>n</italic> = 354 (32.42 %), aOR 1.84), current CD4+ T cell count (aOR 0.92), non-availability of HIV type (<italic>n</italic> = 787 (72.07 %), aOR 0.56), chronic cough (<italic>n</italic> = 32 (2.93 %), aOR 5.07), intake of co-trimoxazole (<italic>n</italic> = 271 (24.82 %), aOR 2.31), vitamin supplementation (<italic>n</italic> = 220 (20.15 %), aOR 2.64) as well as the use of mosquito bed nets (<italic>n</italic> = 613 (56.14 %), aOR 1.53).</p></sec><sec><title>Conclusions</title><p>Accelerated TB screening among newly diagnosed HIV-patients indicates that application of the WHO screening form for intensifying tuberculosis case finding among HIV-positive individuals in resource-limited settings is increasingly adopted. However, screening for TB in PLHIV is still impacted by clinician’s perception of patient’s health state and PLHIV’s health awareness. Education of staff, counselling of PLHIV and sufficient financing are needed for further improvement in implementation of TB screening for all PLHIV. The LASSO approach proved a convenient method for automatic variable selection in a large public health data set that requires efficient and fast algorithms.</p></sec><sec><title>Trials registration</title><p>ClinicalTrials.gov <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01897909?term=NCT01897909&rank=1">NCT01897909</ext-link> (July 5, 2013).</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>LASSO</kwd><kwd>Variable selection</kwd><kwd>HIV/AIDS</kwd><kwd>Tuberculosis screening</kwd><kwd>Sub-Saharan Africa</kwd></kwd-group><funding-group><award-group><funding-source><institution>German Federal Ministry of Education and Research</institution></funding-source><award-id>01KA1102</award-id><principal-award-recipient><name><surname>Feldt</surname><given-names>Torsten</given-names></name></principal-award-recipient></award-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/http://dx.doi.org/10.13039/501100001664</institution-id><institution>Leibniz-Gemeinschaft</institution></institution-wrap></funding-source></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2016</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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