An Empiric HIV Risk Scoring Tool to Predict HIV-1 Acquisition in African Women
OBJECTIVE:
To
develop and validate an HIV risk assessment tool to predict HIV acquisition
among African women.
DESIGN:
Data were
analyzed from three randomized trials of biomedical HIV prevention
interventions among African women (VOICE, HPTN 035 and FEM-PrEP).
METHODS:
We
implemented standard methods for the development of clinical prediction rules
to generate a risk-scoring tool to predict HIV acquisition over the course of one
year. Performance of the score was assessed through internal and external
validation.
RESULTS:
The final
risk score resulting from multivariable modeling included age, married/living
with a partner, partner provides financial or material support, partner has
other partners, alcohol use, detection of a curable sexually transmitted
infection, and herpes simplex virus-2 serostatus. Point values for each factor
ranged from 0 to 2, with a maximum possible total score of 11. Scores ≥5 were
associated with HIV incidence >5 per 100 person-years and identified 91% of
incident HIV infections from among only 64% of women. The area under the curve
(AUC) for predictive ability of the score was 0.71 (95% confidence interval
[CI] 0.68, 0.74), indicating good predictive ability. Risk score performance
was generally similar with internal cross-validation (AUC=0.69; 95% CI 0.66,
0.73), and external validation in HPTN 035 (AUC=0.70; 95% CI 0.65, 0.75) and
FEM-PrEP (AUC=0.58; 95% CI 0.51, 0.65).
CONCLUSIONS:
A
discrete set of characteristics that can be easily assessed in clinical and
research settings were predictive of HIV acquisition over one year. Use of a
validated risk score could improve efficiency of recruitment into HIV
prevention research and inform scale-up of HIV prevention strategies in women
at highest risk.
- 1 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Seattle, WA, USA
- 2 Department of Global Health, University of Washington; Seattle, WA, USA
- 3 Department of Epidemiology, University of Washington; Seattle, WA, USA
- 4 Department of Biostatistics, University of Washington; Seattle, WA, USA
- 5 Department of Medicine, University of Washington; Seattle, WA, USA
- 6 Wits Reproductive Health and HIV Institute, University of the Witswatersrand; Johannesburg, South Africa
- 7 Centre for AIDS Programme of Research in South Africa, University of KwaZulu Natal; Durban, South Africa
- 8 HIV Prevention Research Unit, South African Medical Research Council; Durban, South Africa
- 9 Department of Obstetrics and Gynecology, University of Zimbabwe; Harare, Zimbabwe.
- J Acquir Immune Defic Syndr. 2016 Feb 25
No comments:
Post a Comment