Antiretroviral Therapy and Mortality in Rural South Africa: A Comparison of Causal Modeling Approaches.

ABSTRACT: Estimation of causal effects from observational data is a primary goal of epidemiology. The use of multiple methods with different assumptions relating to exchangeability improves causal inference by demonstrating robustness across assumptions. We estimated the effect of antiretroviral therapy (ART) on mortality in rural KwaZulu-Natal, South Africa, from 2007 to 2011, using 2 methods with substantially different assumptions: the regression discontinuity design (RDD) and inverse-probability-weighted (IPW) marginal structural models (MSMs). The RDD analysis took advantage of a CD4-cell-count-based threshold for ART initiation (200 cells/μL). The 2 methods yielded consistent but nonidentical results for the effect of immediate initiation of ART (RDD intention-to-treat hazard ratio (HR) = 0.66

SUBMITTER: Oldenburg CE 

PROVIDER: S-EPMC6070080 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature