Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Factors associated with performing tuberculosis screening of HIV-positive patients in Ghana: LASSO-based predictor selection in a large public health data set

Authors: Susanne Mueller-Using, Torsten Feldt, Fred Stephen Sarfo, Kirsten Alexandra Eberhardt

Published in: BMC Public Health | Issue 1/2016

Login to get access

Abstract

Background

The purpose of this study is to propose the Least Absolute Shrinkage and Selection Operators procedure (LASSO) as an alternative to conventional variable selection models, as it allows for easy interpretation and handles multicollinearities. We developed a model on the basis of LASSO-selected parameters in order to link associated demographical, socio-economical, clinical and immunological factors to performing tuberculosis screening in HIV-positive patients in Ghana.

Methods

Applying the LASSO method and multivariate logistic regression analysis on a large public health data set, we selected relevant predictors related to tuberculosis screening.

Results

One Thousand Ninety Five patients infected with HIV were enrolled into this study with 691 (63.2 %) of them having tuberculosis screening documented in their patient folders. Predictors found to be significantly associated with performance of tuberculosis screening can be classified into factors related to the clinician’s perception of the clinical state, as well as those related to PLHIV’s awareness. These factors include newly diagnosed HIV infections (n = 354 (32.42 %), aOR 1.84), current CD4+ T cell count (aOR 0.92), non-availability of HIV type (n = 787 (72.07 %), aOR 0.56), chronic cough (n = 32 (2.93 %), aOR 5.07), intake of co-trimoxazole (n = 271 (24.82 %), aOR 2.31), vitamin supplementation (n = 220 (20.15 %), aOR 2.64) as well as the use of mosquito bed nets (n = 613 (56.14 %), aOR 1.53).

Conclusions

Accelerated TB screening among newly diagnosed HIV-patients indicates that application of the WHO screening form for intensifying tuberculosis case finding among HIV-positive individuals in resource-limited settings is increasingly adopted. However, screening for TB in PLHIV is still impacted by clinician’s perception of patient’s health state and PLHIV’s health awareness. Education of staff, counselling of PLHIV and sufficient financing are needed for further improvement in implementation of TB screening for all PLHIV. The LASSO approach proved a convenient method for automatic variable selection in a large public health data set that requires efficient and fast algorithms.

Trials registration

ClinicalTrials.gov NCT01897909 (July 5, 2013).
Literature
1.
Acharjee A, Finkers R, Visser RG, Maliepaard C. Comparison of regularized regression methods for ~ omics data. Metabolomics. 2013;3:126.
2.
Derksen S, Keselman H. Backward, forward and stepwise automated subset selection algorithms: frequency of obtaining authentic and noise variables. Br J Math Stat Psychol. 1992;45(2):265–82.CrossRef
3.
Díaz I, Hubbard A, Decker A, Cohen M. Variable importance and prediction methods for longitudinal problems with missing variables. PLoS One. 2015;10(3):e0120031.CrossRefPubMedPubMedCentral
4.
Shimizu Y, Yoshimoto J, Toki S, Takamura M, Yoshimura S, Okamoto Y, Yamawaki S, Doya K. Toward probabilistic diagnosis and understanding of depression based on functional MRI Data Analysis with Logistic Group LASSO. PLoS One. 2015;10(5):e0123524.CrossRefPubMedPubMedCentral
5.
Tibshirani R. Regression Shrinkage and Selection via the Lasso. Journal of the Royal Statistic Society, Series B (Methodological). 1996;58(1):267–88.
6.
7.
8.
Sculier D, Getahun H, Lienhardt C. Improving the prevention, diagnosis and treatment of TB among people living with HIV: the role of operational research. J Int AIDS Soc. 2011;14 Suppl 1:S5.CrossRefPubMedPubMedCentral
9.
10.
11.
Howard AA, El-Sadr WM. Integration of tuberculosis and HIV services in sub-Saharan Africa: lessons learned. Clin Infect Dis. 2010;50 Suppl 3:S238–244.CrossRefPubMed
12.
Harries AD, Lawn SD, Getahun H, Zachariah R, Havlir DV. HIV and tuberculosis--science and implementation to turn the tide and reduce deaths. J Int AIDS Soc. 2012;15(2):17396.CrossRefPubMedPubMedCentral
13.
Ansa GA, Walley JD, Siddiqi K, Wei X. Assessing the impact of TB/HIV services integration on TB treatment outcomes and their relevance in TB/HIV monitoring in Ghana. Infect Dis Poverty. 2012;1(1):13.CrossRefPubMedPubMedCentral
14.
Chand S. On Tuning Parameter Selection of Lasso-Type Methods - A Monte Carlo Study. Islamabad, Pakistan: Applied Sciences and Technology (IBCAST), 9th International Bhurban Conference; 2012. p. 120–9.
15.
Hastie T, Tibshirani R, Friedman J. The Elements of Statistical Learning. Data Mining, Inference and Prediction. 2nd ed. New York, NY 10013, USA: Springer; 2013.
16.
Hebiri M, Lederer JC. How correlations influence Lasso prediction. Information Theory, IEEE Transactions. 2013;59(3):1846–54.CrossRef
17.
Oyeyemi GM, Ogunjobi EO, Folorunsho AI. On performance of shrinkage methods – a Monte Carlo Study. International Journal of Statistics and Applications. 2015;5(2):72–6.
18.
Cohen J, Cohen P. Applied multiple regression-correlation analysis for the behavioral sciences. 2nd ed. Hillsdale (New Jersey): Lawrence Erlbaum Associates; 1983.
19.
20.
21.
Raviglione M, Marais B, Floyd K, Lönnroth K, Getahun H, Migliori GB, Harries AD, Nunn P, Lienhardt C, Graham S, et al. Scaling up interventions to achieve global tuberculosis control: progress and new developments. Lancet. 2012;379(9829):1902–13.CrossRefPubMed
22.
Atun R, Pothapregada SK, Kwansah J, Degbotse D, Lazarus JV. Critical interactions between the Global Fund-supported HIV programs and the health system in Ghana. J Acquir Immune Defic Syndr. 2011;57 Suppl 2:72–6.CrossRef
23.
Bjerrum S, Kenu E, Lartey M, Newman MJ, Addo KK, Andersen AB, Johansen IS. Diagnostic accuracy of the rapid urine lipoarabinomannan test for pulmonary tuberculosis among HIV-infected adults in Ghana-findings from the DETECT HIV-TB study. BMC Infect Dis. 2015;15(1):407.CrossRefPubMedPubMedCentral
24.
25.
Finnie RK, Khoza LB, van den Borne B, Mabunda T, Abotchie P, Mullen PD. Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV. Trop Med Int Health. 2011;16(4):394–411.CrossRefPubMed
26.
Zwerling AA, Sahu M, Ngwira LG, Khundi M, Harawa T, Corbett EL, Chaisson RE, Dowdy DW. Screening for tuberculosis among adults newly diagnosed with hiv in sub-saharan africa: a cost-effectiveness analysis. J Acquir Immune Defic Syndr. 2015;70(1):83–90.CrossRefPubMed
27.
Daftary A, Padayatchi N. Integrating patients’ perspectives into integrated tuberculosis-human immunodeficiency virus health care. Int J Tuberc Lung Dis. 2013;17(4):546–51.CrossRefPubMedPubMedCentral
28.
Getahun H, Kittikraisak W, Heilig CM, Corbett EL, Ayles H, Cain KP, Grant AD, Churchyard GJ, Kimerling M, Shah S, et al. Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Med. 2011;8(1):e1000391.CrossRefPubMedPubMedCentral
29.
Otwombe KN, Variava E, Holmes CB, Chaisson RE, Martinson N. Predictors of delay in the diagnosis and treatment of suspected tuberculosis in HIV co-infected patients in South Africa. Int J Tuberc Lung Dis. 2013;17(9):1199–205.CrossRefPubMed
30.
31.
Osei E, Akweongo P, Binka F. Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana. BMC Public Health. 2015;15:721.CrossRefPubMedPubMedCentral
32.
Ansa GA, Walley JD, Siddiqi K, Wei X. Delivering TB/HIV services in Ghana: a comparative study of service delivery models. Trans R Soc Trop Med Hyg. 2014;108(9):560–7.CrossRefPubMed
33.
Uwinkindi F, Nsanzimana S, Riedel DJ, Muhayimpundu R, Remera E, Gasana M, Mutembayire G, Binagwaho A. Scaling up intensified tuberculosis case finding in HIV clinics in Rwanda. J Acquir Immune Defic Syndr. 2014;66(2):e45–49.PubMed
34.
Uyei J, Coetzee D, Macinko J, Guttmacher S. Integrated delivery of HIV and tuberculosis services in sub-Saharan Africa: a systematic review. Lancet Infect Dis. 2011;11(11):855–67.CrossRefPubMed
35.
Chehab JC, Vilakazi-Nhlapo AK, Vranken P, Peters A, Klausner JD. Current integration of tuberculosis (TB) and HIV services in South Africa, 2011. PLoS One. 2013;8(3):e57791.CrossRefPubMedPubMedCentral
36.
Amo-Adjei J. Perspectives of stakeholders on the sustainability of tuberculosis control programme in Ghana. Tuberc Res Treat. 2013;2013:419385.PubMedPubMedCentral
37.
Kenu E, Käser M. Coinfection as a challenge of the health system. TB/HIV/AIDS - prevention and treatment in Ghana. Pharm Unserer Zeit. 2012;41(1):58–63.CrossRefPubMed
Metadata
Title
Factors associated with performing tuberculosis screening of HIV-positive patients in Ghana: LASSO-based predictor selection in a large public health data set
Authors
Susanne Mueller-Using
Torsten Feldt
Fred Stephen Sarfo
Kirsten Alexandra Eberhardt
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3239-y

Other articles of this Issue 1/2016

BMC Public Health 1/2016 Go to the issue

Research article

Socioeconomic and race/ethnic disparities in observed park quality

Research article

The analysis of factors affecting municipal employees’ willingness to report to work during an influenza pandemic by means of the extended parallel process model (EPPM)

Study protocol

New Zealand’s new alcohol laws: protocol for a mixed-methods evaluation

Research article

The Lund University Checklist for Incipient Exhaustion–a cross–sectional comparison of a new instrument with similar contemporary tools

Research article

Factors associated with late Human Immunodeficiency Virus (HIV) diagnosis among peoples living with it, Northwest Ethiopia: hospital based unmatched case-control study

Research article

Sedentary bout durations and metabolic syndrome among working adults: a prospective cohort study