When screening for infectious diseases, group testing has proven to be a cost efficient alternative to individual level testing. Cost savings are realized by testing pools of individual specimens (eg, blood, urine, saliva, and so on) rather than by testing the specimens separately. However, a common concern that arises in group testing is the so‐called “dilution effect.” This occurs if the signal from a positive individual's specimen is diluted past an assay's threshold of detection when it is pooled with multiple negative specimens. In this article, we propose a new statistical framework for group testing data that merges estimation and case identification, which are often treated separately in the literature. Our approach considers analyzing continuous biomarker levels (eg, antibody levels, antigen concentrations, and so on) from pooled samples to estimate both a binary regression model for the probability of disease and the biomarker distributions for cases and controls. To increase case identification accuracy, we then show how estimates of the biomarker distributions can be used to select diagnostic thresholds on a pool‐by‐pool basis. Our proposals are evaluated through numerical studies and are illustrated using hepatitis B virus data collected on a prison population in Ireland.
- Award ID(s):
- 1826715
- NSF-PAR ID:
- 10228696
- Date Published:
- Journal Name:
- Biostatistics
- Volume:
- 21
- Issue:
- 3
- ISSN:
- 1468-4357
- Page Range / eLocation ID:
- 417 to 431
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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An accurate estimation of the residual risk of transfusion‐transmittable infections (TTIs), which includes the human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV), among others, is essential, as it provides the basis for blood screening assay selection. While the highly sensitive nucleic acid testing (NAT) technology has recently become available, it is highly costly. As a result, in most countries, including the United States, the current practice for human immunodeficiency virus, hepatitis B virus, hepatitis C virus screening in donated blood is to use pooled NAT. Pooling substantially reduces the number of tests required, especially for TTIs with low prevalence rates. However, pooling also reduces the test's sensitivity, because the viral load of an infected sample might be diluted by the other samples in the pool to the point that it is not detectable by NAT, leading to potential TTIs. Infection‐free blood may also be falsely discarded, resulting in wasted blood. We derive expressions for the residual risk, expected number of tests, and expected amount of blood wasted for various two‐stage pooled testing schemes, including Dorfman‐type and array‐based testing, considering infection progression, infectivity of the blood unit, and imperfect tests under the dilution effect and measurement errors. We then calibrate our model using published data and perform a case study. Our study offers key insights on how pooled NAT, used within different testing schemes, contributes to the safety and cost of blood. Copyright © 2016 John Wiley & Sons, Ltd.
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Group testing is a technique that can reduce the number of tests needed to identify infected members in a population, by pooling together multiple diagnostic samples. Despite the variety and importance of prior results, traditional work on group testing has typically assumed independent infections. However, contagious diseases among humans, like SARS-CoV-2, have an important characteristic: infections are governed by community spread, and are therefore correlated. In this paper, we explore this observation and we argue that taking into account the community structure when testing can lead to significant savings in terms of the number of tests required to guarantee a given identification accuracy. To show that, we start with a simplistic (yet practical) infection model, where the entire population is organized in (possibly overlapping) communities and the infection probability of an individual depends on the communities (s)he participates in. Given this model, we compute new lower bounds on the number of tests for zero-error identification and design community-aware group testing algorithms that can be optimal under assumptions. Finally, we demonstrate significant benefits over traditional, community-agnostic group testing via simulations using both noiseless and noisy testsmore » « less
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Funding: This work was supported by the National Science Foundation [Grant 1761842].
Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0296 .
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1093/biostatistics/kxy058
