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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
An empiric risk scoring tool for identifying high-risk heterosexual HIV-1-Serodiscordant couples for targeted HIV-1 prevention
Journal of Acquired Immune Deficiency Syndromes, Volume 62, No. 3, Year 2013
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Description
Background and objectives: 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. Methods: Using data from 3 prospective studies of HIV-1-serodiscordant couples from 7 African countries and standard methods for development of clinical prediction rules, the authors 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. Results: 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% confidence interval: 0.70 to 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. Conclusions: 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. Copyright © 2012 by Lippincott Williams and Wilkins.
Authors & Co-Authors
Kahle, Erin M.
United States, Seattle
University of Washington
Hughes, James P.
United States, Seattle
University of Washington
Lingappa, Jairam R.
United States, Seattle
University of Washington
John-Stewart, Grace C.
United States, Seattle
University of Washington
Celum, Connie L.
United States, Seattle
University of Washington
Nakku-Joloba, Edith
Uganda, Kampala
Makerere University
Njuguna, Stella W.
Kenya, Nairobi
Global Programs for Research and Training
Mugo, Nelly Rwamba
United States, Seattle
University of Washington
Kenya, Nairobi
Kenyatta National Hospital
Bukusi, Elizabeth Anne
Kenya, Nairobi
Global Programs for Research and Training
Manongi, Rachel N.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Baeten, Jared M.
United States, Seattle
University of Washington
Statistics
Citations: 126
Authors: 11
Affiliations: 5
Identifiers
Doi:
10.1097/QAI.0b013e31827e622d
ISSN:
15254135
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Participants Gender
Male