Assessing Direct and Spillover Effects of Intervention Packages in Network-randomized Studies.

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Epidemiology Pub Date : 2024-07-01 Epub Date: 2024-05-06 DOI:10.1097/EDE.0000000000001742
Ashley L Buchanan, Raúl U Hernández-Ramírez, Judith J Lok, Sten H Vermund, Samuel R Friedman, Laura Forastiere, Donna Spiegelman
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Abstract

Background: Intervention packages may result in a greater public health impact than single interventions. Understanding the separate impact of each component on the overall package effectiveness can improve intervention delivery.

Methods: We adapted an approach to evaluate the effects of a time-varying intervention package in a network-randomized study. In some network-randomized studies, only a subset of participants in exposed networks receive the intervention themselves. The spillover effect contrasts average potential outcomes if a person was not exposed to themselves under intervention in the network versus no intervention in a control network. We estimated the effects of components of the intervention package in HIV Prevention Trials Network 037, a Phase III network-randomized HIV prevention trial among people who inject drugs and their risk networks using marginal structural models to adjust for time-varying confounding. The index participant in an intervention network received a peer education intervention initially at baseline, then boosters at 6 and 12 months. All participants were followed to ascertain HIV risk behaviors.

Results: There were 560 participants with at least one follow-up visit, 48% of whom were randomized to the intervention, and 1,598 participant visits were observed. The spillover effect of the boosters in the presence of initial peer education training was a 39% rate reduction (rate ratio = 0.61; 95% confidence interval = 0.43, 0.87).

Conclusions: These methods will be useful for evaluating intervention packages in studies with network features.

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在网络随机研究中评估一揽子干预措施的直接效应和溢出效应。
背景:一揽子干预措施可能比单一干预措施对公众健康产生更大的影响。了解每个组成部分对一揽子干预措施整体效果的单独影响可以改进干预措施的实施:我们采用了一种方法,在网络随机研究中评估随时间变化的一揽子干预措施的效果。在一些网络随机研究中,只有暴露在网络中的一部分参与者本身会接受干预。溢出效应对比了在网络干预与对照网络无干预的情况下,如果一个人没有接触到自己可能产生的平均结果。我们使用边际结构模型来调整时变混杂因素,估算了第 037 号艾滋病预防试验网络(HIV Prevention Trials Network 037)中干预方案各组成部分的效果,这是一项在注射吸毒者及其风险网络中进行的第三阶段网络随机艾滋病预防试验。干预网络中的指数参与者最初在基线时接受同伴教育干预,然后在 6 个月和 12 个月时接受强化干预。对所有参与者进行跟踪调查,以确定其艾滋病风险行为:结果:共有 560 名参与者接受了至少一次随访,其中 48% 的参与者被随机分配接受干预,共观察到 1598 次随访。在初始同伴教育培训的基础上,助推器的溢出效应使感染率降低了 39%(比率 = 0.61;95% 置信区间 = 0.43,0.87):这些方法将有助于评估具有网络特征的研究中的一揽子干预措施。
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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
期刊最新文献
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