Assessing the effect of hormonal contraception on HIV acquisition in observational data: challenges and recommended analytic approaches.
Assessing the effect of hormonal contraception on HIV acquisition in observational data: challenges and recommended analytic approaches.
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DOI：
10.1097/qad.0000000000000036
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发表时间：
2013-10
期刊：
影响因子：
--
通讯作者：
Participants of the 2013 HC-HIV Observational Analysis Meeting
中科院分区：
文献类型：
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作者：
Polis CB;Westreich D;Balkus JE;Heffron R;Participants of the 2013 HC-HIV Observational Analysis Meeting
确定激素避孕（HC），特别是注射避孕药库-醋酸甲羟孕酮（DMPA）是否会增加妇女感染艾滋病毒的风险是公共卫生的一个优先问题。然而，利用观测数据评估各种HC方法与HIV感染之间的关系涉及大量的分析设计问题和挑战。迄今为止的研究使用了不一致的方法，并产生了大量复杂且难以解释的证据。2013年1月，美国国际开发署和FHI 360支持召开了一次由流行病学家、统计学家和内容专家参加的会议，为今后艾滋病毒感染和艾滋病毒感染的观察分析提出建议。与会者提出了关于仔细定义接触群体的建议；处理潜在的混杂因素、调节剂和效果调节剂；测量误差大小的估计和处理；使用多种方法解释妊娠；探索与感染艾滋病毒的伴侣有不同接触的可能性。讨论了各种统计方法在解释时变混杂和估计总效应和直接效应方面的优缺点。在未来的观察性hiv获取分析中实施这些建议将加强对现有研究的解释，并加强这一复杂而重要领域的整体证据基础。
Determining whether hormonal contraception (HC), particularly the injectable contraceptive depot-medroxyprogesterone acetate (DMPA), increases a woman's risk of HIV acquisition is a priority question for public health. However, assessing the relationship between various HC methods and HIV acquisition with observational data involves substantial analytic design issues and challenges. Studies to date have used inconsistent approaches and generated a body of evidence that is complex and challenging to interpret. In January 2013, USAID and FHI 360 supported a meeting of epidemiologists, statisticians, and content experts to develop recommendations for future observational analyses of HC and HIV acquisition. Meeting participants generated recommendations regarding careful definition of exposure groups; handling potential confounders, mediators, and effect modifiers; estimating and addressing the magnitude of measurement error; using multiple methods to account for pregnancy; and exploring the potential for differential exposure to HIV-infected partners. Advantages and disadvantages of various statistical approaches to account for time-varying confounding and estimating total and direct effects were also discussed. Implementing these recommendations in future observational HC-HIV acquisition analyses will enhance interpretation of existing studies and strengthen the overall evidence base for this complex and important area.