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E-raamat: Methodological Challenges in Biomedical HIV Prevention Trials

  • Formaat: 270 pages
  • Ilmumisaeg: 13-May-2008
  • Kirjastus: National Academies Press
  • Keel: eng
  • ISBN-13: 9780309114318
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  • Formaat: 270 pages
  • Ilmumisaeg: 13-May-2008
  • Kirjastus: National Academies Press
  • Keel: eng
  • ISBN-13: 9780309114318

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The number of people infected with HIV or living with AIDS is increasing at unprecedented rates as various scientists, organizations, and institutions search for innovative solutions to combating and preventing the disease. At the request of the Bill & Melinda Gates Foundation, Methodological Challenges in Biomedical HIV Prevention Trials addresses methodological challenges in late-stage nonvaccine biomedical HIV prevention trials with a specific focus on microbicide and pre-exposure prophylaxis trials. This book recommends a number of ways to improve the design, monitoring, and analysis of late-stage clinical trials that evaluate nonvaccine biomedical interventions. The objectives include identifying a beneficial method of intervention, enhancing quantification of the impact, properly assessing the effects of using such an intervention, and reducing biases that can lead to false positive trial results.





According to Methodological Challenges in Biomedical HIV Prevention Trials, the need to identify a range of effective, practical, and affordable preventive strategies is critical. Although a large number of promising new HIV prevention strategies and products are currently being tested in late-stage clinical trials, these trials face a myriad of methodological challenges that slow the pace of research and limit the ability to identify and fully evaluate effective biomedical interventions.





Table of Contents



Front Matter Summary Introduction 1 The Status and Challenges of Biomedical HIV Prevention Trials 2 Basic Design Features: Size, Duration, and Type of Trials, and Choice of Control Group 3 Design Considerations: Risk-Reduction Counseling 4 Design Considerations: Pregnancy 5 Design Considerations: Adherence 6 Design Considerations: Recruitment and Retention 7 Site Preparedness 8 Estimating HIV Incidence 9 Interim Monitoring and Analysis of Results 10 Alternative Designs Appendix A: Public Committee Meeting Agendas Appendix B: Acronyms Appendix C: Supporting Materials for Chapter 2 Appendix D: Methods for Analyzing Adherence Appendix E: Committee Biographies
Summary 1(26)
Introduction 27(1)
Charge to the Commitree
28(1)
Scope of Work
29(3)
Study Process
32(1)
Study Considerations
32(1)
Report Structure
33(4)
The Status and Challenges of Biomedical HIV Prevention Trials
37(32)
Recent Late-Stage Trials of Non-Vaccine Biomedical Preventions
47(8)
Methodoogical Challenges in Biomedical HIC Prevention Trials
55(3)
Behavioral and Sociocultral Influences on Biomedical Trials
58(11)
Basic Design Features: Size, Duration, and Type of Trials, and Choice of control Group
69(19)
Trial Sample Size and Duration
69(6)
Efficacty vs. Effectiveness Trials
75(7)
Choice of Control Group
82(6)
Design Considerations: Risk-Reduction Couseling
88(16)
Ethical Reasons for Risk-Reduction Couseling
89(1)
Effectiveness of Behavioral Risk-Reduction Interventions
90(6)
Adapting Efficacious Behavioral Risk-Rdeuction Interventions
96(1)
Evaluating Behavioral Risk-Reduction Interventions in the Context of a Biomedical Intervention Trial
97(2)
Summary
99(5)
Design Considerations: Pregnancy
104(15)
When Pregnancy Occurs During Trials
105(1)
statistical Implications of Pregnancies Orring During Trials
106(1)
Collecting Information on Benfits and Risks
107(12)
Design Considerations: Adherence
119(29)
Defining Adherence
120(3)
Measuring Adherence, Sexual Behavior, and Condom Use
123(8)
Strategies to Improve Adherence
131(4)
Analyzing Adherence
135(13)
Design Consideration: Recruitment and Retention
148(12)
Recruitment Strategies
148(3)
Retention Strategies
151(9)
Site Proparedness
160(15)
Developing Capacity and Infrastructure
160(8)
Pretrial Development
168(1)
Pretrial Research
169(1)
Ensuring Sustainability
170(5)
Estimating HIV Incidence
175(11)
Direct Longitudinal Follow-Up: Cohort Studies
176(1)
Biomarkers of Recent Infection
177(4)
Mathematical Models
181(5)
Interim Monitoring and Anlysis of Results
186(18)
Ensuring Effective Interim Monitoring
186(10)
Analyzing Trial Rcsults
196(8)
Alternative Designs
204(1)
Factorial and Other Multiarm Designs
205(6)
Discordant Couple Designs
211(3)
Noninferiority Designs
214(1)
cluster Randomization
215(4)
Dynamic Designs
219(6)
APPENDIXES
Public Committee Meeting Agendas
225(9)
Acronyms
234(2)
Supporting Materials for
Chapter2
236(9)
Methods for Analyzing Adherence
245(1)
Committee Biographies
250
Stephen W. Lagakos and Alicia R. Gable, Editors, Committee on the Methodological Challenges in HIV Prevention Trials