Estimating treatment effects in studies of perinatal transmission of HIV

Heejung Bang, Donna Spiegelman

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Fetal loss often precludes the ascertainment of infection status in studies of perinatal transmission of HIV. The standard analysis based on liveborn babies can result in biased estimation and invalid inference in the presence of fetal death. This paper focuses on the problem of estimating treatment effects for mother-to-child transmission when infection status is unknown for some babies. Minimal data structures for identifiability of parameters are given. Methods using full likelihood and the inverse probability of selection-weighted estimators are suggested. Simulation studies are used to show that these estimators perform well in finite samples. Methods are applied to the data from a clinical trial in Dar es Salaam, Tanzania. To validly estimate the treatment effect using likelihood methods, investigators should make sure that the design includes a mini-study among uninfected mothers and that efforts are made to ascertain the infection status of as many babies lost as possible. The inverse probability weighting methods need precise estimation of the probability of observing infection status. We can further apply our methodology to the study of other vertically transmissible infections which are potentially fatal pre- and perinatally.

Original languageEnglish (US)
Pages (from-to)31-43
Number of pages13
JournalBiostatistics
Volume5
Issue number1
DOIs
StatePublished - Jan 2004
Externally publishedYes

Keywords

  • AIDS
  • HIV
  • Logistic regression
  • Missing data
  • Perinatal transmission
  • Selection bias
  • Semiparametric efficiency
  • Vertical transmission

ASJC Scopus subject areas

  • Medicine(all)
  • Statistics and Probability
  • Statistics, Probability and Uncertainty

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