Posted: September 23rd, 2022

(5 points each)

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By the end of this activity you will be able to identify how to appropriately design different types of epidemiologic studies.
Instructions
Before beginning this activity, read the module notes and the sections of your text. This activity will walk you through designing studies you learned about this module. You will be asked key questions specific to finalizing hypotheses for study, data collection, and analyses. Almost all of the questions are short answer. However, some questions require calculations. Remember to show your work as partial credit will be given. Review the instructions in each section (there are two sections), and answer each question to the best of your knowledge. For questions that require short calculation, show your work. Save your worksheet to your computer before completing. Once complete, return to the course and follow the instructions to upload and submit your assignment. Section 1: Case study 1
You work for a city health department and you recently reviewed several studies that repeatedly found that higher HIV viral load increases the risk of sexual transmission of HIV. Your city has traditionally seen a high HIV prevalence, but in recent years, numerous campaigns have been launched to reduce incidence including broadening access to care and treatment. At this time, you are interested in if there is an association between viral load and a decrease in HIV transmission.
Based on the knowledge that at the individual level we know that viral load is associated with transmission, you ask your team to design a study to better understand viral load and HIV incidence at the community level.
You request each team member write up a brief proposal that includes a hypothesis, study design choice, and what data sources will be needed. Review each proposal below and decide which team member’s proposal you will choose.
Team Member A
• Hypothesis: The odds of transmission are lower for those who have a low viral load compared to those with a high viral load
• Study design: Cross sectional study
• Data sources needed: The number of transmissions per individual with HIV.
Team Member B
• Hypothesis: Communities in this city with low average viral loads will have lower HIV incidence than those with a higher average viral load
• Study design: Ecologic study
• Data sources needed: Where people with HIV live in your city (zip code level), and what their viral load is. Also, information on incidence of HIV by zip code in your city.
Team Member C
• Hypothesis: HIV incidence has been reduced in communities in this city as a result of increased access to care and treatment.
• Study design: Experimental study
• Data sources needed: Where care and treatment programs are located in your city (zip code level), and what is the incidence of HIV by zip code in your city.
1. In a few sentences, give at least two reasons to support your choice of proposal. (10 points)
Place your answer in the text area below (box will expand to accommodate writing).
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2. Give at least one reason why you did not choose each of the other proposals. (5 points each)
Place your answer in the text area below (box will expand to accommodate writing).
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Section 2: Case study 2
After choosing a team member’s proposal and conducting the study, you decide you want to dig deeper. Given all of the work done in your city to increase access to care, you suspect that there is an association between continuous care and viral load suppression. Viral load suppression is when an individual’s viral load reaches an undetectable level. You are interested in looking at the communities with lower average viral loads to study this association.
You decide to conduct a cross sectional study.
1. What is your best hypothesis given your current knowledge, and study design choice?
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2. You gather information on continuous care (2 or more visits with the same physician in a 12-month period) and viral load suppression from medical records. You find that out of 300 people with continuous care, 200 are virally suppressed. Of the 500 people without continuous care, 350 are not virally suppressed.
Complete the 2×2 table below (5 pts) Viral load – Suppressed
Viral load – Not suppressed
Total
In continuous care
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Not in continuous care
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Total
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3. State the measure of association that you would calculate, and then calculate that measure (show your work, and round to the 100th decimal place at each step). (5 pts)
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4. What is your interpretation of your findings? (5 points)
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Image citations:
Baer, R. (2008). Researchers review documents. [Photograph]. License: Public domain, via Wikimedia Commons
Article 25 Flickr (2014). Public Health… [Photograph]. License: CC BY-SA 2.0, via Wikimedia Commons

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