Age-Specific Risk Scores Do Not Improve HIV-1 Prediction Among Women in South Africa

Peebles, Kathryn; Palanee‐Phillips, Thesla; Balkus, Jennnifer E; Beesham, Ivana; Makkan, Heeran; Deese, Jennifer; Smit, Jennifer; Heffron, Renee; Morrison, Charles; Philip, Neena M.; Malahleha, Mookho; Kasaro, Margaret P.; Naidoo, Yuthika; Nielson, Tanya; Reddy, Krishnaveni; Kotze, Philip; Ahmed, Khatija; Rees, Helen; Baeten, Jared M.; Barnabas, Ruanne V.; Options, Evidence for Contraceptive

doi:10.1097/qai.0000000000002436

Cited by 14 publications

(45 citation statements)

References 54 publications

(59 reference statements)

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“…Only three of 11 multi-site studies considered community-level HIV prevalence as a covariate and all cases where considered it was selected into one or more of the final models [6, 28, 30]. In Peebles [6], compared to residing in a community with 10-15% HIV prevalence, those in a community with 16-20% prevalence had an aHR of 1.64 [1.08, 2.48], 1.71 [0.99, 2.96] for 21-25% prevalence, and 1.81 [1.03, 3.19] for 26-30%. Similarly, in Kagaayi [28], an aHR of 1.03 was associated with each percentage-point increment in community prevalence for both male [0.99,1.07] and female [1.01, 1.06].…”

Section: Resultsmentioning

confidence: 99%

“…In a similar analysis, Peebles 6 found the most important predictors were age (less than 27), being married/cohabiting and the provinces of residence. Three studies [5, 6, 24] additionally provided a “modified score” that excluded the laboratory-diagnosed STIs, which are not routinely available in most settings. Removing laboratory-diagnosed STIs reduced the AUC-ROC by between one to eight percentage-points (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Among studies collecting for all predictors that were intended by the VOICE score (maximum score: 11), above 60% of women scored 5 or above [5, 23, 24]. The threshold for which the observed incidence was >3% varied across populations: in South African samples, Peebles[6] found that incidence was >3% if AGYW scored 3 out of 11, while among the older sample aged 25-34 years only those scoring 6 out of 7 had incidence >3% (16.7% of the sample); in KwaZulu-Natal, Wand [21] observed >3% incidence for 88% of women enrolled in five clinical trials, while in an observational cohort only 60% (3 rd quintile and above) of women had incidence >3% [30].…”

Section: Resultsmentioning

confidence: 99%

“…One additional conference abstract was available after initial screening, adding to a total of 13 risk score literature (9 peer-reviewed articles, 2 posters, 1 editorial letter, 1 abstract) that met the inclusion criteria and were included in this review (Figure 1) [5,6,[20][21][22][23][24][25][26][27][28][29][30]. Critical appraisal according to the PROBAST checklist concluded that one out of twelve models developed and two out of nine validated were of low risk of bias (Figure S1, Table S3 & S4).…”

Section: Resultsmentioning

confidence: 99%

“…Efficiently identifying those at high risk of acquiring HIV from the large population is essential for efficiently and effectively delivering HIV prevention. Several HIV incidence ‘risk scores’ have been proposed as prognostic tools for this purpose [5, 6]. HIV risk scores combine data on multiple prognostic factors into a single score, which is often compared against a threshold to classify individuals among whom specific HIV prevention services are offered or promoted.…”

Section: Introductionmentioning

confidence: 99%

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Risk scores for predicting HIV incidence among adult heterosexual populations in sub-Saharan Africa: a systematic review and meta-analysis

Jia

Eilerts

Edun

et al. 2021

Preprint

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Introduction: Several HIV 'risk scores' have been developed to identify individuals for prioritised HIV prevention in sub-Saharan Africa. We systematically reviewed HIV risk scores to: (i) identify factors that consistently predicted incident HIV infection, (ii) review inclusion of community-level HIV risk in predictive models, and (iii) examine predictive performance. Methods: We systematically searched nine databases for studies developing and/or validating HIV risk scores among the general population in sub-Saharan Africa from database inception until February 15, 2021. Studies not prospectively observing seroconversion or recruiting only key populations were excluded. Record screening, data extraction, and critical appraisal were conducted in duplicate. We used random-effect meta-analysis to summarise hazard ratios and the area under the receiver-operating characteristic curve (AUC-ROC). Results: From 1563 initial search records, we identified 14 risk scores in 13 studies. Seven studies were among sexually active women using contraception enrolled in randomised-controlled trials, three among adolescent girls and young women (AGYW), and three among cohorts enrolling both men and women. Consistently identified HIV prognostic factors among women were younger age (pooled adjusted hazard ratio: 1.62 [95% Confidence Interval: 1.17, 2.23], compared to above-25), single/not cohabiting with primary partners (2.33 [1.73, 3.13]) and having sexually transmitted infections (STIs) at baseline (HSV-2: 1.67 [1.34, 2.09]; curable STIs: 1.45 [1.17; 1.79]). Among AGYW only STIs were consistently associated with higher incidence, but studies were limited (n=3). Community-level HIV prevalence or unsuppressed viral load strongly predicted incidence but were only considered in three of 11 multi-site studies. The AUC-ROC ranged from 0.56 to 0.79 on the model development sets. Only the VOICE score was externally validated by multiple studies, with pooled AUC-ROC 0.626 [0.588, 0.663] (I2: 64.02%). Conclusions: Younger age, non-cohabiting, and recent STIs were consistently identified as predicting future HIV infection. Both community HIV burden and individual factors should be considered to quantify HIV risk. However, HIV risk scores had only low-to-moderate discriminatory ability and uncertain generalizability outside of the study populations. Further evidence on the relative value of specific factors and data outside high-risk populations will help inform optimal implementation of risk scoring algorithms in HIV programmes. PROSPERO Number: CRD42021236367

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Risk scores for predicting HIV incidence among adult heterosexual populations in sub-Saharan Africa: a systematic review and meta-analysis

Jia

Eilerts

Edun

et al. 2021

Preprint

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show abstract

Risk scores for predicting HIV incidence among adult heterosexual populations in sub‐Saharan Africa: a systematic review and meta‐analysis

et al. 2022

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Introduction Several HIV risk scores have been developed to identify individuals for prioritized HIV prevention in sub‐Saharan Africa. We systematically reviewed HIV risk scores to: (1) identify factors that consistently predicted incident HIV infection, (2) review inclusion of community‐level HIV risk in predictive models and (3) examine predictive performance. Methods We searched nine databases from inception until 15 February 2021 for studies developing and/or validating HIV risk scores among the heterosexual adult population in sub‐Saharan Africa. Studies not prospectively observing seroconversion or recruiting only key populations were excluded. Record screening, data extraction and critical appraisal were conducted in duplicate. We used random‐effects meta‐analysis to summarize hazard ratios and the area under the receiver‐operating characteristic curve (AUC‐ROC). Results From 1563 initial search records, we identified 14 risk scores in 13 studies. Seven studies were among sexually active women using contraceptives enrolled in randomized‐controlled trials, three among adolescent girls and young women (AGYW) and three among cohorts enrolling both men and women. Consistently identified HIV prognostic factors among women were younger age (pooled adjusted hazard ratio: 1.62 [95% confidence interval: 1.17, 2.23], compared to above 25), single/not cohabiting with primary partners (2.33 [1.73, 3.13]) and having sexually transmitted infections (STIs) at baseline (HSV‐2: 1.67 [1.34, 2.09]; curable STIs: 1.45 [1.17; 1.79]). Among AGYW, only STIs were consistently associated with higher incidence, but studies were limited ( n = 3). Community‐level HIV prevalence or unsuppressed viral load strongly predicted incidence but was only considered in 3 of 11 multi‐site studies. The AUC‐ROC ranged from 0.56 to 0.79 on the model development sets. Only the VOICE score was externally validated by multiple studies, with pooled AUC‐ROC 0.626 [0.588, 0.663] ( I 2 : 64.02%). Conclusions Younger age, non‐cohabiting and recent STIs were consistently identified as predicting future HIV infection. Both community HIV burden and individual factors should be considered to quantify HIV risk. However, HIV risk scores had only low‐to‐moderate discriminatory ability and uncertain generalizability, limiting their programmatic utility. Further evidence on the relative value of specific risk factors, studies populations not restricted to “at‐risk” individuals and data outside South Africa will improve the evidence base for risk differentiation in HIV prevention programmes. PROSPERO Number CRD42021236367

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My Way: development and preliminary evaluation of a novel delivery system for PrEP and other sexual health needs of young women in Western Kenya

Haberer,

Oware,

Juma

et al. 2024

J Int AIDS Soc.

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IntroductionYoung women in sub‐Saharan Africa are a priority population for HIV prevention, yet challenges with adherence and persistence to HIV pre‐exposure prophylaxis (PrEP) are common. This study involved the development and pilot testing of My Way—a novel delivery system for PrEP and co‐packaged sexual health services.MethodsMy Way was developed in Kisumu, Kenya through a user‐centred design process (2020). The intervention involves peer‐delivery and support for HIV testing and PrEP use, self‐collected vaginal swabs for sexually transmitted infection (STI) testing, pregnancy testing, oral contraceptive pills, self‐injectable medroxyprogesterone and/or condoms. My Way was assessed among 16‐ to 24‐year‐old sexually active women in a randomized controlled trial versus standard of care (SoC; 2021–2022). Use of PrEP and other sexual health services were tracked at 1, 3 and 6 months for feasibility. Acceptability was determined by questionnaire. The effect of the intervention on tenofovir diphosphate (TFV‐DP) levels was assessed by chi‐square test (primary outcome); other predictors were explored with regression analysis.ResultsAmong 150 women, the median age was 22 years and the median number of sexual partners was 2. Moderate/severe depression was common (60%). In the intervention arm, peers made 88% (198/225) of possible kit deliveries (177 with PrEP) and 49 STIs were diagnosed. In the SoC arm, 24% (55/225) of expected clinic visits occurred (53 with PrEP); no STI testing was performed. TVF‐DP was detected in 16 participants at 6 months: 16% (12/75) in the intervention arm versus 5% (4/75) in the SoC arm (p = 0.03). Persistence among those with ongoing HIV prevention needs (i.e. prevention‐effective persistence) was 18% (12/67) versus 7% (4/56; p = 0.08). No women acquired HIV. The intervention was significantly associated with detectable TFV‐DP (OR 3.5, 1.1‐11.4; p = 0.04); moderate/severe depression trended towards an association with TFV‐DP (OR 0.2, 0.03–1.6; p = 0.13).ConclusionsMy Way is a promising delivery system for PrEP and other sexual health services among young women in Western Kenya. We found high feasibility and acceptability. PrEP use was modest, but higher with My Way compared to SoC. Long‐acting PrEP formulations may overcome important barriers to PrEP use and should be explored in combination with the My Way delivery model.

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Age-Specific Risk Scores Do Not Improve HIV-1 Prediction Among Women in South Africa

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 14 publications

References 54 publications

Risk scores for predicting HIV incidence among adult heterosexual populations in sub-Saharan Africa: a systematic review and meta-analysis

Risk scores for predicting HIV incidence among adult heterosexual populations in sub-Saharan Africa: a systematic review and meta-analysis

Risk scores for predicting HIV incidence among adult heterosexual populations in sub‐Saharan Africa: a systematic review and meta‐analysis

My Way: development and preliminary evaluation of a novel delivery system for PrEP and other sexual health needs of young women in Western Kenya

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