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Reducing contamination risk in cluster-randomized infectious disease-intervention trials.

Abstract：

Background:Infectious disease interventions are increasingly tested using cluster-randomized trials (CRTs). These trial settings tend to involve a set of sampling units, such as villages, whose geographic arrangement may present a contamination risk in treatment exposure. The most widely used approach for reducing contamination in these settings is the so-called fried-egg design, which excludes the outer portion of all available clusters from the primary trial analysis. However, the fried-egg design ignores potential intra-cluster spatial heterogeneity and makes the outcome measure inherently less precise. Whereas the fried-egg design may be appropriate in specific settings, alternative methods to optimize the design of CRTs in other settings are lacking. Methods:We present a novel approach for CRT design that either fully includes or fully excludes available clusters in a defined study region, recognizing the potential for intra-cluster spatial heterogeneity. The approach includes an algorithm that allows investigators to identify the maximum number of clusters that could be included for a defined study region and maintain randomness in both the selection of included clusters and the allocation of clusters to either the treatment group or control group. The approach was applied to the design of a CRT testing the effectiveness of malaria vector-control interventions in southern Malawi. Conclusions:Those planning CRTs to evaluate interventions should consider the approach presented here during trial design. The approach provides a novel framework for reducing the risk of contamination among the CRT randomization units in settings where investigators determine the reduction of contamination risk as a high priority and where intra-cluster spatial heterogeneity is likely. By maintaining randomness in the allocation of clusters to either the treatment group or control group, the approach also permits a randomization-valid test of the primary trial hypothesis.

journal_name

Int J Epidemiol

journal_title

International journal of epidemiology

authors

McCann RS,van den Berg H,Takken W,Chetwynd AG,Giorgi E,Terlouw DJ,Diggle PJ

doi

10.1093/ije/dyy213

subject

Has Abstract

pub_date

2018-12-01 00:00:00

pages

2015-2024

issue

eissn

0300-5771

issn

1464-3685

pii

5146518

journal_volume

pub_type

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Reducing contamination risk in cluster-randomized infectious disease-intervention trials.