20
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Conceptualizing Care Continua: Lessons from HIV, Hepatitis C Virus, Tuberculosis and Implications for the Development of Improved Care and Prevention Continua

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          To examine the application of continuum models to tuberculosis, HIV, and other conditions; to theorize the concept of continua; and to learn lessons that could inform the development of improved care and prevention continua as public health metrics.

          Methods

          An analytic review of literature drawn from several fields of health care.

          Results

          The continuum construct is now part of public health evaluation systems for HIV, and is increasingly used in public health and the medical literature. Issues with the comparability and optimal design of care continuum models have been raised, and their methodologic and theoretic underpinnings and scope of focus have been under-addressed. Review of relevant publications suggests that a key limitation of current models is their lack of measures reflecting incidence and mortality. Issues relating to continua data being longitudinal or cross-sectional, definition of numerators and denominators for each step, data sources, measures of timeliness of step completion, theoretic models to facilitate inferences of causes of care continuum gaps, how measures of prevention efforts, reinfection/relapses, and interactions of continua for co-occurring comorbidities should be reflected, and how analyses of differences in retention over time, across geographic regions, and in response to interventions should be conducted are critical to the development of sound care and prevention continuum models.

          Conclusion

          Lessons learned from the application of continuum models to HIV and other conditions suggest that the application of well-formulated constructs of care and prevention continua, that depict, in well defined, standardized steps, incidence and mortality, along with degrees of and time to screening, engagement in care and prevention, treatment and treatment outcomes, including relapse or reinfection, may be vital tools in evaluating intervention and program outcomes, and in improving population health and population health metrics for a wide range conditions.

          Related collections

          Most cited references46

          • Record: found
          • Abstract: found
          • Article: not found

          Regression models for ordinal responses: a review of methods and applications.

          Epidemiologists are often interested in estimating the risk of several related diseases as well as adverse outcomes, which have a natural ordering of severity or certainty. While most investigators choose to model several dichotomous outcomes (such as very low birthweight versus normal and moderately low birthweight versus normal), this approach does not fully utilize the available information. Several statistical models for ordinal responses have been proposed, but have been underutilized. In this paper, we describe statistical methods for modelling ordinal response data, and illustrate the fit of these models to a large database from a perinatal health programme. Models considered here include (1) the cumulative logit model, (2) continuation-ratio model, (3) constrained and unconstrained partial proportional odds models, (4) adjacent-category logit model, (5) polytomous logistic model, and (6) stereotype logistic model. We illustrate and compare the fit of these models on a perinatal database, to study the impact of midline episiotomy procedure on perineal lacerations during labour and delivery. Finally, we provide a discussion on graphical methods for the assessment of model assumptions and model constraints, and conclude with a discussion on the choice of an ordinal model. The primary focus in this paper is the formulation of ordinal models, interpretation of model parameters, and their implications for epidemiological research. This paper presents a synthesized review of generalized linear regression models for analysing ordered responses. We recommend that the analyst performs (i) goodness-of-fit tests and an analysis of residuals, (ii) sensitivity analysis by fitting and comparing different models, and (iii) by graphically examining the model assumptions.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Proximal, distal, and the politics of causation: what's level got to do with it?

            Causal thinking in public health, and especially in the growing literature on social determinants of health, routinely employs the terminology of proximal (or downstream) and distal (or upstream). I argue that the use of these terms is problematic and adversely affects public health research, practice, and causal accountability. At issue are distortions created by conflating measures of space, time, level, and causal strength. To make this case, I draw on an ecosocial perspective to show how public health got caught in the middle of the problematic proximal-distal divide--surprisingly embraced by both biomedical and social determinist frameworks--and propose replacing the terms proximal and distal with explicit language about levels, pathways, and power.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Insights and Pitfalls: Selection Bias in Qualitative Research

                Bookmark

                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                10 January 2017
                2016
                : 4
                : 296
                Affiliations
                [1] 1Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel , New York, NY, USA
                [2] 2Center for Drug Use and HIV Research , New York, NY, USA
                [3] 3Department of Epidemiology, School of Public Health, City University of New York , New York, NY, USA
                [4] 4Center for Drug Use and HIV Research , New York, NY, USA
                Author notes

                Edited by: Jimmy Thomas Efird, East Carolina University, USA

                Reviewed by: Eugenia M. Bastos, Bastos Consulting, USA; Brian Godman, Karolinska Institutet, Sweden

                *Correspondence: David C. Perlman, dperlman@ 123456chpnet.org

                Specialty section: This article was submitted to Epidemiology, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2016.00296
                5222805
                28119910
                999486e0-767f-4674-ba58-4511cf884e44
                Copyright © 2017 Perlman, Jordan and Nash.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 27 October 2016
                : 23 December 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 76, Pages: 9, Words: 8358
                Categories
                Public Health
                Review

                care continuum,cascade of care,hiv,hepatitis c,treatment and prevention

                Comments

                Comment on this article