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Am J Epidemiol. 2018 Feb 1;187(2):316-325. doi: 10.1093/aje/kwx247.

Evaluating the Population Impact on Racial/Ethnic Disparities in HIV in Adulthood of Intervening on Specific Targets: A Conceptual and Methodological Framework.

Author information

1
Centers for Epidemiology and Environmental Health, Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
2
Center for Health Equity Research, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island.
3
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
4
Center for Statistical Sciences, Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island.
5
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
6
University of California San Diego Medical Center, San Diego, California.
7
Department of Medicine, School of Medicine, University of Washington, Seattle, Washington.
8
The Fenway Institute, Fenway Health, Boston, Massachusetts.
9
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
10
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.

Abstract

Reducing racial/ethnic disparities in human immunodeficiency virus (HIV) disease is a high priority. Reductions in HIV racial/ethnic disparities can potentially be achieved by intervening on important intermediate factors. The potential population impact of intervening on intermediates can be evaluated using observational data when certain conditions are met. However, using standard stratification-based approaches commonly employed in the observational HIV literature to estimate the potential population impact in this setting may yield results that do not accurately estimate quantities of interest. Here we describe a useful conceptual and methodological framework for using observational data to appropriately evaluate the impact on HIV racial/ethnic disparities of interventions. This framework reframes relevant scientific questions in terms of a controlled direct effect and estimates a corresponding proportion eliminated. We review methods and conditions sufficient for accurate estimation within the proposed framework. We use the framework to analyze data on 2,329 participants in the CFAR [Centers for AIDS Research] Network of Integrated Clinical Systems (2008-2014) to evaluate the potential impact of universal prescription of and ≥95% adherence to antiretroviral therapy on racial disparities in HIV virological suppression. We encourage the use of the described framework to appropriately evaluate the potential impact of targeted interventions in addressing HIV racial/ethnic disparities using observational data.

KEYWORDS:

HIV; health status disparities

PMID:
28992096
PMCID:
PMC5860258
DOI:
10.1093/aje/kwx247
[Indexed for MEDLINE]
Free PMC Article

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