An Empiric HIV Risk Scoring Tool to Predict HIV-1 Acquisition in African Women - PubMed (original) (raw)

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

Jennifer E Balkus et al. J Acquir Immune Defic Syndr. 2016.

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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.

FIGURE 1.

HIV incidence and 95% CIs by risk score using the full risk score (A) and modified risk score that excludes variables for any curable STI at baseline and HSV-2 serostatus (B).

FIGURE 2.

FIGURE 2.

Cumulative incidence curves of HIV acquisition stratified by HIV risk score cut-point. PPV: positive predictive value; NPV: negative predictive value.

FIGURE 3.

FIGURE 3.

HIV incidence and 95% CIs by risk score for HPTN 035 (A) and FEM-PrEP (B). HPTN 035 score includes variables for age, marital/cohabiting status, partner provides financial support, partner has other partners, any curable STI at baseline, and HSV-2 status. Point values for each variable are the same as in the full risk score. FEM-PrEP score includes variables for age (<25 = 1 point), marital/cohabiting status (no = 1 point), partner has other partners (yes or do not know = 1 point), and any curable STI at baseline (yes = 1 point).

References

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