应用因果森林双重机器学习 (DML) 方法来评估结核病预防治疗对ART坚持的影响
Abraham Keffale Mengistu1, Kelemua Aschale Yeneakale2, Nebebe Demis Baykemagn3
1Department of Health Informatics, College of Medicine Health Science, Debre Markos University, Debre Markos, Ethiopia. abreham_keffale@dmu.edu.et.
结核病预防疗法 (TPT) 略有降低了HIV患者抗逆转录病毒疗法 (ART) 的坚持. 然而,需要个性化TPT策略,因为影响根据个体患者的特征和疾病阶段而有很大差异.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 流行病学 流行病学
背景情况:
- 坚持抗逆转录病毒疗法 (ART) 对于控制艾滋病毒感染至关重要.
- 结核病预防治疗 (TPT) 对ART坚持的影响尚未得到充分证实.
- 了解这种相互作用对于优化艾滋病毒和结核病联合管理至关重要.
研究的目的:
- 估计TPT启动对艾滋病毒患者ART坚持的因果关系.
- 确定患者子组,这些患者经历了TPT对ART坚持的差异性影响.
- 在艾滋病毒护理中为个性化的TPT策略提供信息.
主要方法:
- 使用埃塞俄比亚4152名艾滋病毒患者 (2005-2024) 的数据进行的观察性研究.
- 应用因果推理方法:调整后勤回归,倾向得分匹配和因果森林双机器学习 (DML).
- 模型比较以选择最精确的估计方法 (DML).
主要成果:
- 开始TPT与ART坚持率平均减少3.14个百分点有关 (ATE = -0.0314; p < 0.001).
- 在患者子组中观察到TPT对坚持的影响的显著异质性.
- 晚期WHO阶段,更长的ART持续时间,更高的BMI或年龄较大的患者表现出更好的对TPT的坚持反应.
结论:
- 平均而言,TPT启动对ART坚持有很小但在统计学上显著的负面影响.
- 患者的特征,包括疾病严重程度和治疗史,显著改变TPT对坚持的影响.
- 结果支持量身定制的TPT实施,优先考虑高风险患者和监测弱势群体,以确保最佳的HIV治疗结果.
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