arXiv subjects

Moses R. Kamya

Publications and source records attributed to Moses R. Kamya.

3 recordsLinked to original sources

arXiv2026

A causal framework for evaluating the total effect of strategies aiming to expand screening and to improve outcomes

For many health conditions, there are highly efficacious treatment and prevention products. Maximizing their impact requires strategies that improve the reach of health screening in order to establish who could benefit. For example, HIV prevention strategies aim to expand risk screening and to improve uptake of pre-exposure prophylaxis (PrEP) among those experiencing risk. Often, these strategies induce changes at the group-level (e.g., health clinics or communities) and are evaluated through cluster randomized trials. This scenario creates a complex, multilevel-mediation-missing data problem for the following reasons. First, the strategy is delivered at the cluster-level, while health screening and outcomes are at the individual-level. Second, the strategy improves health outcomes directly and indirectly through improved health screening. Third, everyone has an underlying status, which is only observed among those screened. To formally define the total effect in such settings, we use Counterfactual Strata Effects: causal estimands where the outcome is only relevant for a group whose membership is subject to missingness and/ or impacted by the exposure of interest. To identify and estimate the corresponding statistical estimand, we propose a novel extension of Two-Stage targeted minimum loss-based estimation (TMLE). Simulations demonstrate the practical performance of our approach as well as the limitations of existing approaches.

stat.ME↗

arXiv2026

Causal Inference with Missing Exposures and Missing Outcomes

Missing data are ubiquitous in public health research. When estimating causal effects, there are well-established methods to address bias to due missing outcomes. Commonly, causal estimands are defined under hypothetical interventions to "set" the exposure and to prevent missingness. We demonstrate how this framework can be extended to missing exposures. We further extend this framework to incorporate missingness on the baseline outcome, which induces missingness on the population of interest (e.g., persons at-risk). To do so, we highlight Counterfactual Strata Effects, a general class of causal estimands where the focus population is subject to missingness and/or impacted by the exposure. They are termed such because the estimand involves conditioning on a counterfactual variable.For each setting, we present the causal model, relevant counterfactuals, causal estimand, and identification result. We demonstrate with a real-data example to investigate the effect of alcohol consumption on the risk of incident tuberculosis (TB) infection in rural Uganda. We highlight the use of TMLE with Super Learner for estimation and inference and discuss the practical consequences of our approach.

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arXiv2024

When exposure affects subgroup membership: Framing relevant causal questions in perinatal epidemiology and beyond

Perinatal epidemiology often aims to evaluate exposures on infant outcomes. When the exposure affects the composition of people who give birth to live infants (e.g., by affecting fertility, behavior, or birth outcomes), this "live birth process" mediates the exposure effect on infant outcomes. Causal estimands previously proposed for this setting include the total exposure effect on composite birth and infant outcomes, controlled direct effects (e.g., enforcing birth), and principal stratum direct effects. Using perinatal HIV transmission in the SEARCH Study as a motivating example, we present two alternative causal estimands: 1) conditional total effects; and 2) conditional stochastic direct effects, formulated under a hypothetical intervention to draw mediator values from some distribution (possibly conditional on covariates). The proposed conditional total effect includes impacts of an intervention that operate by changing the types of people who have a live birth and the timing of births. The proposed conditional stochastic direct effects isolate the effect of an exposure on infant outcomes excluding any impacts through this live birth process. In SEARCH, this approach quantifies the impact of a universal testing and treatment intervention on infant HIV-free survival absent any effect of the intervention on the live birth process, within a clearly defined target population of women of reproductive age with HIV at study baseline. Our approach has implications for the evaluation of intervention effects in perinatal epidemiology broadly, and whenever causal effects within a subgroup are of interest and exposure affects membership in the subgroup.

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