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Statistical issues in trials of preexposure prophylaxis

Dunn, DT; Glidden, DV; (2016) Statistical issues in trials of preexposure prophylaxis. Current Opinion in HIV and AIDS , 11 (1) pp. 116-121. 10.1097/COH.0000000000000218. Green open access

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Abstract

Purpose of review We discuss selected statistical issues in the design and analysis of preexposure prophylaxis (PrEP) trials. The general principles may inform thinking for other interventions in HIV prevention. Recent findings To date, four different designs have been used to determine the effectiveness of PrEP: randomized, doubleblind, placebo-controlled; randomized, open-label, immediate or delayed access; nonrandomized comparison of HIV incidence according to the level of drug detected; comparison of the observed HIV incidence to the expected rate using historical control data. Open-label trials of PrEP, which assess public health effectiveness, complement the placebo-controlled trials which established the biological efficacy of TDF/ FTC. Future trials of PrEP will be highly challenging to design since a no PrEP group is difficult to justify and the natural control regimen, TDF/FTC, is highly efficacious. Summary Standard statistical paradigms for noninferiority trials should be reconsidered for evaluating alternative PrEP regimens.

Type: Article
Title: Statistical issues in trials of preexposure prophylaxis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/COH.0000000000000218
Publisher version: http://dx.doi.org/10.1097/COH.0000000000000218
Language: English
Additional information: Copyright © 2015 Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/1497301
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