A Scoring Tool to Identify East African HIV-1 Serodiscordant Partnerships with a High Likelihood of Pregnancy

Introduction

HIV-1 prevention programs targeting HIV-1 serodiscordant couples need to identify couples that are likely to become pregnant to facilitate discussions about methods to minimize HIV-1 risk during pregnancy attempts (i.e. safer conception) or effective contraception when pregnancy is unintended. A clinical prediction tool could be used to identify HIV-1 serodiscordant couples with a high likelihood of pregnancy within one year.

Methods

Using standardized clinical prediction methods, we developed and validated a tool to identify heterosexual East African HIV-1 serodiscordant couples with an increased likelihood of becoming pregnant in the next year. Datasets were from three prospectively followed cohorts, including nearly 7,000 couples from Kenya and Uganda participating in HIV-1 prevention trials and delivery projects.

Results

The final score encompassed the age of the woman, woman’s number of children living, partnership duration, having had condomless sex in the past month, and non-use of an effective contraceptive. The area under the curve (AUC) for the probability of the score to correctly predict pregnancy was 0.74 (95% CI 0.72–0.76). Scores ≥7 predicted a pregnancy incidence of >17% per year and captured 78% of the pregnancies. Internal and external validation confirmed the predictive ability of the score.

Discussion

A pregnancy likelihood score encompassing basic demographic, clinical and behavioral factors defined African HIV-1 serodiscordant couples with high one-year pregnancy incidence rates. This tool could be used to engage African HIV-1 serodiscordant couples in counseling discussions about fertility intentions in order to offer services for safer conception or contraception that align with their reproductive goals.

Below:  Pregnancy incidence rates by score among women in the A) Partners PrEP Study B) Partners in Prevention HSV/HIV Transmission Study at Kenyan and Ugandan sites and C) Partners Demonstration Project.

Full article at:   http://goo.gl/uBRQFe

By:   

Renee Heffron, Kenneth Ngure, Elizabeth Bukusi, Nelly Mugo, Connie Celum, Jared M. Baeten

Department of Global Health, University of Washington, Seattle, United States of America

Renee Heffron, Connie Celum, Jared M. Baeten

Department of Epidemiology, University of Washington, Seattle, United States of America

Connie Celum, Jared M. Baeten

Department of Medicine, University of Washington, Seattle, United States of America

Craig R. Cohen

Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, United States of America

Kenneth Ngure

Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya

Elizabeth Bukusi

Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya

Nelly Mugo

Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya

Nelly Mugo

Department of Obstetrics & Gynecology, Kenya Medical Research Institute, Nairobi, Kenya

Edwin Were

Department of Reproductive Health, Moi University, Eldoret, Kenya

James Kiarie

Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health