title: Factors associated with performing tuberculosis screening of HIV-positive patients in Ghana: LASSO-based predictor selection in a large public health data set.
abstract: The purpose of this study is to propose the Least Absolute Shrinkage and Selection Operators procedure (LASSO) as an alternative to conventional variable selection models, as it allows for easy interpretation and handles multicollinearities. We developed a model on the basis of LASSO-selected parameters in order to link associated demographical, socio-economical, clinical and immunological factors to performing tuberculosis screening in HIV-positive patients in Ghana.
  
  
  
  Applying the LASSO method and multivariate logistic regression analysis on a large public health data set, we selected relevant predictors related to tuberculosis screening.
  
  
  
  One Thousand Ninety Five patients infected with HIV were enrolled into this study with 691 (63.2 %) of them having tuberculosis screening documented in their patient folders. Predictors found to be significantly associated with performance of tuberculosis screening can be classified into factors related to the clinician's perception of the clinical state, as well as those related to PLHIV's awareness. These factors include newly diagnosed HIV infections (n = 354 (32.42 %), aOR 1.84), current CD4+ T cell count (aOR 0.92), non-availability of HIV type (n = 787 (72.07 %), aOR 0.56), chronic cough (n = 32 (2.93 %), aOR 5.07), intake of co-trimoxazole (n = 271 (24.82 %), aOR 2.31), vitamin supplementation (n = 220 (20.15 %), aOR 2.64) as well as the use of mosquito bed nets (n = 613 (56.14 %), aOR 1.53).
  
  
  
  Accelerated TB screening among newly diagnosed HIV-patients indicates that application of the WHO screening form for intensifying tuberculosis case finding among HIV-positive individuals in resource-limited settings is increasingly adopted. However, screening for TB in PLHIV is still impacted by clinician's perception of patient's health state and PLHIV's health awareness. Education of staff, counselling of PLHIV and sufficient financing are needed for further improvement in implementation of TB screening for all PLHIV. The LASSO approach proved a convenient method for automatic variable selection in a large public health data set that requires efficient and fast algorithms.
  
  
  
  ClinicalTrials.gov NCT01897909 (July 5, 2013).
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany.|Hamburg Institute of International Economics, Heimhuder Str. 71, 20148, Hamburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Mueller-Using
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany.|Clinic of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of the Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Feldt
authors.affiliation: Kwame Nkrumah University of Science and Technology, University Post Office - KNUST, Kumasi, Ghana.|Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana.
authors.forename: Fred Stephen
authors.initials: FS
authors.lastname: Sarfo
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany. k.eberhardt@bnitm.de.
authors.forename: Kirsten Alexandra
authors.initials: KA
authors.lastname: Eberhardt
mesh_terms: D000328:Adult; D000465:Algorithms; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D005869:Ghana; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance; D011634:Public Health / Q000706:statistics & numerical data; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014376:Tuberculosis / Q000175:diagnosis* / Q000517:prevention & control
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: HIV/AIDS; LASSO; Sub-Saharan Africa; Tuberculosis screening; Variable selection