An empiric risk scoring tool for identifying high-risk heterosexual HIV-1 serodiscordant couples for targeted HIV-1 prevention
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Date
2012Author
Kahle, EM
Hughes, JP
Lingappa, JR
John-Stewart, G
Celum, C
Nakku-Joloba, E
Njuguna, S
Mugo, N
Bukusi, EA
Manongi, R
Baeten, JM
Type
ArticleLanguage
enMetadata
Show full item recordAbstract
Heterosexual HIV-1 serodiscordant couples are increasingly recognized as an important source of new HIV-1 infections in sub-Saharan Africa. A simple risk assessment tool could be useful for identifying couples at highest risk for HIV-1 transmission. Using data from three prospective studies of HIV-1 serodiscordant couples from seven African countries and standard methods for development of clinical prediction rules, we derived and validated a risk scoring tool developed from multivariate modeling and composed of key predictors for HIV-1 risk that could be measured in standard research and clinical settings. The final risk score included age of the HIV-1 uninfected partner, married and/or cohabiting partnership, number of children, unprotected sex, uncircumcised male HIV-1 uninfected partner, and plasma HIV-1 RNA in the HIV-1 infected partner. The maximum risk score was 12, scores ≥5 were associated with an annual HIV-1 incidence of >3%, and couples with a score ≥6 accounted for only 28% of the population but 67% of HIV-1 transmissions. The area under the curve for predictive ability of the score was 0.74 (95% CI 0.70-0.78). Internal and external validation showed similar predictive ability of the risk score, even when plasma viral load was excluded from the risk score. A discrete combination of clinical and behavioral characteristics defines highest-risk HIV-1 serodiscordant couples. Discriminating highest-risk couples for HIV-1 prevention programs and clinical trials using a validated risk score could improve research efficiency and maximize the impact of prevention strategies for reducing HIV-1 transmission.
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http://www.ncbi.nlm.nih.gov/pubmed/23187945http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/32269
Citation
J Acquir Immune Defic Syndr. 2012 Nov 26.Collections
- Faculty of Health Sciences (FHS) [10377]