Observational research on NCDs in HIV-positive populations: Conceptual and methodological considerations

Maya Petersen, Constantin Yiannoutsos, Amy Justice, Matthias Egger

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Noncommunicable diseases (NCDs) account for a growing burden of morbidity and mortality among people living with HIV in low-and middle-income countries (LMICs). HIV infection and antiretroviral therapy interact with NCD risk factors in complex ways, and research into this "web of causation" has so far been largely based on data from high-income countries. However, improving the understanding, treatment, and prevention of NCDs in LMICs requires region-specific evidence. Priority research areas include: (1) defining the burden of NCDs among people living with HIV, (2) understanding the impact of modifiable risk factors, (3) evaluating effective and efficient care strategies at individual and health systems levels, and (4) evaluating cost-effective prevention strategies. Meeting these needs will require observational data, both to inform the design of randomized trials and to replace trials that would be unethical or infeasible. Focusing on Sub-Saharan Africa, we discuss data resources currently available to inform this effort and consider key limitations and methodological challenges. Existing data resources often lack population-based samples; HIV-negative, HIV-positive, and antiretroviral therapy-naive comparison groups; and measurements of key NCD risk factors and outcomes. Other challenges include loss to follow-up, competing risk of death, incomplete outcome ascertainment and measurement of factors affecting clinical decision making, and the need to control for (time-dependent) confounding. We review these challenges and discuss strategies for overcoming them through augmented data collection and appropriate analysis. We conclude with recommendations to improve the quality of data and analyses available to inform the response to HIV and NCD comorbidity in LMICs.

Original languageEnglish
JournalJournal of Acquired Immune Deficiency Syndromes
Volume67
Issue numberSUPPL.1
DOIs
StatePublished - 2014

Fingerprint

HIV
Research
Population
HIV-2
Africa South of the Sahara
Causality
Health Status
HIV Infections
Comorbidity
Morbidity
Costs and Cost Analysis
Mortality
Therapeutics

Keywords

  • casual inference
  • cohorts
  • HIV/AIDS
  • loss to follow-up
  • resource limited settings
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Observational research on NCDs in HIV-positive populations : Conceptual and methodological considerations. / Petersen, Maya; Yiannoutsos, Constantin; Justice, Amy; Egger, Matthias.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 67, No. SUPPL.1, 2014.

Research output: Contribution to journalArticle

@article{8990fe88e0eb40e18d63d4a08f3cc236,
title = "Observational research on NCDs in HIV-positive populations: Conceptual and methodological considerations",
abstract = "Noncommunicable diseases (NCDs) account for a growing burden of morbidity and mortality among people living with HIV in low-and middle-income countries (LMICs). HIV infection and antiretroviral therapy interact with NCD risk factors in complex ways, and research into this {"}web of causation{"} has so far been largely based on data from high-income countries. However, improving the understanding, treatment, and prevention of NCDs in LMICs requires region-specific evidence. Priority research areas include: (1) defining the burden of NCDs among people living with HIV, (2) understanding the impact of modifiable risk factors, (3) evaluating effective and efficient care strategies at individual and health systems levels, and (4) evaluating cost-effective prevention strategies. Meeting these needs will require observational data, both to inform the design of randomized trials and to replace trials that would be unethical or infeasible. Focusing on Sub-Saharan Africa, we discuss data resources currently available to inform this effort and consider key limitations and methodological challenges. Existing data resources often lack population-based samples; HIV-negative, HIV-positive, and antiretroviral therapy-naive comparison groups; and measurements of key NCD risk factors and outcomes. Other challenges include loss to follow-up, competing risk of death, incomplete outcome ascertainment and measurement of factors affecting clinical decision making, and the need to control for (time-dependent) confounding. We review these challenges and discuss strategies for overcoming them through augmented data collection and appropriate analysis. We conclude with recommendations to improve the quality of data and analyses available to inform the response to HIV and NCD comorbidity in LMICs.",
keywords = "casual inference, cohorts, HIV/AIDS, loss to follow-up, resource limited settings, Sub-Saharan Africa",
author = "Maya Petersen and Constantin Yiannoutsos and Amy Justice and Matthias Egger",
year = "2014",
doi = "10.1097/QAI.0000000000000253",
language = "English",
volume = "67",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "SUPPL.1",

}

TY - JOUR

T1 - Observational research on NCDs in HIV-positive populations

T2 - Conceptual and methodological considerations

AU - Petersen, Maya

AU - Yiannoutsos, Constantin

AU - Justice, Amy

AU - Egger, Matthias

PY - 2014

Y1 - 2014

N2 - Noncommunicable diseases (NCDs) account for a growing burden of morbidity and mortality among people living with HIV in low-and middle-income countries (LMICs). HIV infection and antiretroviral therapy interact with NCD risk factors in complex ways, and research into this "web of causation" has so far been largely based on data from high-income countries. However, improving the understanding, treatment, and prevention of NCDs in LMICs requires region-specific evidence. Priority research areas include: (1) defining the burden of NCDs among people living with HIV, (2) understanding the impact of modifiable risk factors, (3) evaluating effective and efficient care strategies at individual and health systems levels, and (4) evaluating cost-effective prevention strategies. Meeting these needs will require observational data, both to inform the design of randomized trials and to replace trials that would be unethical or infeasible. Focusing on Sub-Saharan Africa, we discuss data resources currently available to inform this effort and consider key limitations and methodological challenges. Existing data resources often lack population-based samples; HIV-negative, HIV-positive, and antiretroviral therapy-naive comparison groups; and measurements of key NCD risk factors and outcomes. Other challenges include loss to follow-up, competing risk of death, incomplete outcome ascertainment and measurement of factors affecting clinical decision making, and the need to control for (time-dependent) confounding. We review these challenges and discuss strategies for overcoming them through augmented data collection and appropriate analysis. We conclude with recommendations to improve the quality of data and analyses available to inform the response to HIV and NCD comorbidity in LMICs.

AB - Noncommunicable diseases (NCDs) account for a growing burden of morbidity and mortality among people living with HIV in low-and middle-income countries (LMICs). HIV infection and antiretroviral therapy interact with NCD risk factors in complex ways, and research into this "web of causation" has so far been largely based on data from high-income countries. However, improving the understanding, treatment, and prevention of NCDs in LMICs requires region-specific evidence. Priority research areas include: (1) defining the burden of NCDs among people living with HIV, (2) understanding the impact of modifiable risk factors, (3) evaluating effective and efficient care strategies at individual and health systems levels, and (4) evaluating cost-effective prevention strategies. Meeting these needs will require observational data, both to inform the design of randomized trials and to replace trials that would be unethical or infeasible. Focusing on Sub-Saharan Africa, we discuss data resources currently available to inform this effort and consider key limitations and methodological challenges. Existing data resources often lack population-based samples; HIV-negative, HIV-positive, and antiretroviral therapy-naive comparison groups; and measurements of key NCD risk factors and outcomes. Other challenges include loss to follow-up, competing risk of death, incomplete outcome ascertainment and measurement of factors affecting clinical decision making, and the need to control for (time-dependent) confounding. We review these challenges and discuss strategies for overcoming them through augmented data collection and appropriate analysis. We conclude with recommendations to improve the quality of data and analyses available to inform the response to HIV and NCD comorbidity in LMICs.

KW - casual inference

KW - cohorts

KW - HIV/AIDS

KW - loss to follow-up

KW - resource limited settings

KW - Sub-Saharan Africa

UR - http://www.scopus.com/inward/record.url?scp=84906063795&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906063795&partnerID=8YFLogxK

U2 - 10.1097/QAI.0000000000000253

DO - 10.1097/QAI.0000000000000253

M3 - Article

C2 - 25117964

AN - SCOPUS:84906063795

VL - 67

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - SUPPL.1

ER -