An Empiric HIV Risk Scoring Tool to Predict HIV-1... : JAIDS Journal of Acquired Immune Deficiency Syndromes (original) (raw)

Epidemiology and Prevention

An Empiric HIV Risk Scoring Tool to Predict HIV-1 Acquisition in African Women

Balkus, Jennifer E. PhD, MPH*,†,‡; Brown, Elizabeth ScD*,§; Palanee, Thesla PhD‖; Nair, Gonasagrie MBChB¶; Gafoor, Zakir MMedSci#; Zhang, Jingyang PhD*; Richardson, Barbra A. PhD†,§; Chirenje, Zvavahera M. MD, FRCOG**; Marrazzo, Jeanne M. MD, MPH††; Baeten, Jared M. MD, PhD†,‡,††

*Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA;

Departments of †Global Health;

‡Epidemiology;

§Biostatistics University of Washington, Seattle, WA;

‖Wits Reproductive Health and HIV Institute, University of the Witswatersrand, Johannesburg, South Africa;

¶Centre for AIDS Programme of Research in South Africa, University of KwaZulu Natal, Durban, South Africa;

#HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa;

**Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe; and

††Department of Medicine, University of Washington, Seattle, WA.

Correspondence to: Jennifer E. Balkus, PhD, MPH, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., M2-C200, PO Box 19024, Seattle, WA 98109-1024 (e-mail: [email protected]).

Supported in part by a grant from the US National Institutes of Health (NIH) (R03MH106352) and a 2014 developmental grant from the University of Washington Center for AIDS Research (CFAR), an NIH funded program under award number P30AI027757, which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, and NIDDK. The Microbicide Trials Network (MTN) is funded by NIAID (UM1AI068633, UM1AI068615, and UM1AI106707), with cofunding from NICHD and NIMH, all components of the NIH. HIV Prevention Trials Network (HPTN) 035 was funded by the NIH. The trial was designed and implemented by the HPTN and the MTN. FEM-PrEP was funded by grants from the US Agency for International Development (GPO-A-00-05-00022-00 and GHO-A-00-09-00016-00) with early support from the Bill and Melinda Gates Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Presented in part at the HIV Research for Prevention Conference, October 28–31, 2014, Cape Town, South Africa.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Abstract

Objective:

To develop and validate an HIV risk assessment tool to predict HIV acquisition among African women.

Design:

Data were analyzed from 3 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 1 year. Performance of the score was assessed through internal and external validations.

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 to 0.74), indicating good predictive ability. Risk score performance was generally similar with internal cross-validation (AUC = 0.69; 95% CI: 0.66 to 0.73) and external validation in HPTN 035 (AUC = 0.70; 95% CI: 0.65 to 0.75) and FEM-PrEP (AUC = 0.58; 95% CI: 0.51 to 0.65).

Conclusions:

A discrete set of characteristics that can be easily assessed in clinical and research settings was predictive of HIV acquisition over 1 year. The 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.