Closing the gap: A novel metric of change in performance

RICHARD KATURAMU (1) , JEANNA WALLENTA LAW (2) , FRED C SEMITALA (3) , GIDEON AMANYIRE (4) , LEATITIA KAMPIIRE (5) , ENNIFER NAMUSOBYA (6) , MOSES R. KAMYA1 (7) , DIANE HAVLIR (8) , DAVID V. GLIDDEN (9) , ELVIN GENG (10)
(1) , Uganda
(2) Dept. of Medicine, Division of HIV, ID and Global Medicine, University of California, San Francisco, USA , United States
(3) Makerere University, Kampala, Uganda , Uganda
(4) Makerere University Joint AIDS Program, Kampala, Uganda , Uganda
(5) Makerere University, Kampala, Uganda , Uganda
(6) University Research Co., LLC (URC), Kampala, Uganda , Uganda
(7) Makerere University, Kampala, Uganda , Uganda
(8) Dept. of Medicine, Division of HIV, ID and Global Medicine, University of California, San Francisco, USA , United States
(9) Dept. of Medicine, Division of HIV, ID and Global Medicine, University of California, San Francisco, USA , United States
(10) Dept. of Medicine, Division of HIV, ID and Global Medicine, University of California, San Francisco, USA , United States

Abstract

BACKGROUND


Interventions to improve performance of global programs in the HIV cascade of care are widespread and increasing the focus of implementation science. At present, however, there is no clear consensus on how to conceptualize their improvement at the program level. The commonly used measures of association, based on ratios of probabilities (or odds), have well-known defects in public health applications. They yield large effect sizes even when the absolute effects, and therefore the public health impact, are small. On the other hand, risk differences create problems because settings with higher baseline values are penalized. We aim to examine ways of quantifying improvement in each health center of a cluster-randomized trial in Uganda to accelerate antiretroviral therapy initiation among HIV-infected adults.


METHODS


We formalize the concept of the ‘improvement index,’ defined as the fraction of gaps closed as a metric of improvement, and suggest that it has unique features and strengths when compared to risk ratios and risk differences.


RESULTS


Overall agreement between the different indices was not high, especially among health centers that were among the top 5 or 10. However, all ranking showed broad similarities at the far ends of the spectrum. On scatter plots, there was a positive linear relationship between the metrics, and the Bland Altman (B-A) plots were in agreement.


CONCLUSION


The improvement index can be used as an alternative measure of association in implementation science interventions. It can be useful for public health purposes as it demonstrates how much can be covered from the baseline.

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Authors

RICHARD KATURAMU
rkaturamu@gmail.com (Primary Contact)
JEANNA WALLENTA LAW
FRED C SEMITALA
GIDEON AMANYIRE
LEATITIA KAMPIIRE
ENNIFER NAMUSOBYA
MOSES R. KAMYA1
DIANE HAVLIR
DAVID V. GLIDDEN
ELVIN GENG
KATURAMU, R. ., LAW, J. W., SEMITALA, F. C., AMANYIRE, G., KAMPIIRE, L., NAMUSOBYA, E., KAMYA1, M. R., HAVLIR, D., GLIDDEN, D. V., & GENG, E. (2019). Closing the gap: : A novel metric of change in performance. Eajahme, 3(3). https://doi.org/10.58498/eajahme.v1i1.19
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