Haber Noah, Pillay Deenan, Porter Kholoud, Bärnighausen Till
aHarvard T.H. Chan School of Public Health, Boston, Massachusetts, USA bWellcome Trust Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa cDivision of Infection and Immunity dMRC Clinical Trials Unit, University College London, London, UK.
Curr Opin HIV AIDS. 2016 Jan;11(1):102-8. doi: 10.1097/COH.0000000000000212.
Although the concept of the HIV treatment cascade has reached nearly ubiquitous acceptance in international HIV policy and research, methods for estimating it vary drastically. These variations become increasingly important as the focus of the HIV response shifts from emergency response to long-term outcomes and financial and organizational sustainability. We review the history of the cascade and the current literature and develop the first comprehensive typology of cascade scope and methods.
We define the cascade scope in terms of both breadth (range from first to final event) and depth (given breadth, number of cascade stages that analyzed). We distinguish cascade measurement according to four dimensions: denominator-denominator linkage (data used for cascade construction are linked at the individual level across stages); denominator-numerator linkage (data are linked at the individual level within each stage); single vs. multiple populations from which data sources are drawn; and longitudinal vs. cross-sectional design.
Everything else equal, we would prefer broader and deeper cascades, denominator-denominator linkage, denominator-numerator linkage, single population, and longitudinal data over their respective alternatives. Increased investments in population-based cohorts and data linkage are required to complement clinical cohorts for 'broad' longitudinal cascade analyses.
尽管艾滋病病毒治疗级联的概念在国际艾滋病病毒政策和研究中几乎已被普遍接受，但估计它的方法却有很大差异。随着艾滋病应对重点从应急转向长期结果以及财务和组织可持续性，这些差异变得越来越重要。我们回顾了级联的历史和当前文献，并开发了第一个关于级联范围和方法的综合类型学。
我们从广度（从第一个事件到最后一个事件的范围）和深度（给定广度下分析的级联阶段数量）两个方面定义级联范围。我们根据四个维度区分级联测量：分母-分母关联（用于构建级联的数据在各阶段的个体层面上相链接）；分母-分子关联（数据在每个阶段的个体层面上相链接）；从中提取数据源的单个人口与多个人口；以及纵向设计与横断面设计。
在其他条件相同的情况下，与各自的替代方案相比，我们更倾向于更广泛和更深入的级联、分母-分母关联、分母-分子关联、单个人口和纵向数据。需要增加对基于人群的队列和数据关联的投资，以补充临床队列用于“广泛的”纵向级联分析。
