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When One is Not Enough: Randomisation by Community

When One is Not Enough: Randomisation by Community. Neal Alexander. Why randomise by community or cluster Historical development of cluster-randomised trials Emphasis on infectious diseases Recent and current contributions of TEG. Outline.

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When One is Not Enough: Randomisation by Community

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  1. When One is Not Enough:Randomisation by Community Neal Alexander

  2. Why randomise by community or cluster Historical development of cluster-randomised trials Emphasis on infectious diseases Recent and current contributions of TEG Outline

  3. Rationale: some interventions are difficult or impossible to allocate or assess individually Freeman et al 2012 TMIH

  4. Infections are ‘dependent happenings’

  5. Pollock 1966 WHO monograph

  6. Ferebee et al (1963): isoniazid prophylaxis in mental institutions

  7. The Gambia Hepatitis Intervention Study (1987)

  8. Bednets in Gambian villages (Snow et al 1988)

  9. Indirect effects (Halloran et al 1991)

  10. Management of STDs for HIV (Grosskurth et al 1995)

  11. Lancet 2009

  12. Cluster Hostels Mine shaft • Compares: • community-wide isoniazid preventive therapy vs • standard of TB care • 1ary endpoint: TB incidence over 12 months • Results unveiled at CROI 2012 by Fielding & Churchyard

  13. % annual rainfall in 3 months 2009

  14. Design & Analysis of Trials to Compare Genetic Selection Coefficients

  15. Spatial Analysis of ‘Spillover’ km Anaya-Izquierdo et al in prep; trial in Kroeger et al BMJ 2002

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