1.

The prevalence rate of HIV in the following populations are as follows;

Population Antenatal mothers Blood donors Drug Addicts Prevalence rate 0.03% 0.09% 20.00%

If we are using a screening test for HIV with a sensitivity of 99.9% and specificity of 99.9%; calculate the following for each group of population, assuming that each group of population consists of 10,000 people; a) b) c) d) e) f) TP = True Positive FP = False Positive FN = False Negative TN = True Negative PPV = Positive Predictive Value NPV = Negative Predictive Value

Use tables such as the examples below to help calculate your answers. Population Antenatal mothers Blood donors Drug addicts Prevalence rate 0.03% 0.09% 20.00% Disease Absent Population with HIV Population without HIV TOTAL 10,000 10,000 10,000

Disease Present Positive Negativ e Total

Total

2. 10,000 people were screened for diabetes mellitus. Of these, 50 people had a positive result on the screening test; of those who tested positive, 30 had a confirmatory diagnosis of diabetes mellitus. Among the remaining 9,950 people who screened negative, 120 had diabetes and were assumed false negatives to the screen.

a. b.

Set up the two-by-two table for these data. What is the prevalence of diabetes mellitus in the population?

c. d.

Calculate and interpret the sensitivity of this screening test. Calculate and interpret the specificity of this screening test.

3. A study was conducted to test the suitability of one new test kit use in disease A screening program based on the available test . The results are shown below: Disease A Test Result Positive Negative Total marks) Yes 130 24 154 No 99 397 496 Total 229 421 650

a. Calculate the sensitivity and specificity of the test. Explain your results. (40 b. Calculate the positive predictive and negative predictive value of the test.
Explain your results. (40 marks)

c. Discuss the suitability of the test based on your results. (20 marks)

4.

In a hypothetical study, 1000 patients attending a hospital general outpatient department were tested for diabetes using the following two tests: Fasting blood sugar (FBS) Glucose tolerance test (GTT) There were 100 patients who had a positive GTT, and they were classified as true cases of diabetes. There were also 140 patients with an FBS of at least 6 mmol/l (the cutoff point to distinguish people with diabetes from those who do not have diabetes). Among these 140 patients, only 98 were true cases of diabetes (i.e. only 98 had a positive GTT as well).

a)

Fill in the blanks with correct number. (copy the table to your answer sheet)

(20 marks)

Diabetes (GTT) FBS Test Positive Positive Negative Total

Test Negative Total

b)

What are the sensitivity, specificity, positive and negative predictive values of the FBS test in this study population? marks) (20

c)

When the cut off point for the FBS was raised to 7 mmol/l, the sensitivity of the test decreased to 95% and the specificity increased to 98% in the hypothetical population. The 2 x 2 table is given below: Diabetes (GTT)

FBS Test Positive

Positive 95

Negative

Total

Test Negative

Total

100

1000

i)

Fill in the blanks with the correct number. (copy the table to your answer sheet) (20 marks)

ii)

Calculate PPV and false negative error rate.

(20 marks)

iii)

Why is the PPV different from that observed in the hypothetical hospital-based study? (20

marks)

5. Table I shows the results obtained in a screening test for diabetes used on 10,000 persons. The cutoff level was a blood glucose value of 180mg/dl or above as positive for diabetes. a. Calculate sensitivity, specificity and the predictive value of a positive test. Table I
Test Result Positive Negative Total Diabetic 34 116 150 True Diagnosis Not Diabetic 20 9,830 9,850 Total 54 9,946 10,000

b. When the screening cutoff point was lowered to a blood glucose value of 130 mg/dl, 98 of 164 persons who then tested positive were among the 9,850 persons judged by diagnostic tests not to have diabetes. (Table II) Calculate the sensitivity, specificity and predictive value of a positive test at this cutoff point. (Fill in the blanks before calculating). Table II
Test Result Positive Negative Total Diabetic True Diagnosis Not Diabetic 98 9,850 Total 164 10,000

150

c. What effect do you get from lowering the screening cutoff point in terms of falsepositive and false-negative findings and predictive value of a positive test?

d. How does this affect the sensitivity?