Identifying Adolescent Girls and Young Women at High Risk for HIV Acquisition: A Risk Assessment Tool From the Girl Power-Malawi Study

Abstract

Background: Prioritizing HIV prevention for adolescent girls and young women (AGYW) at high risk of HIV acquisition in sub-Saharan Africa (typically considered ≥3 per 100 person years [PYs]) is urgently needed, but identifying these AGYW is challenging. We sought to assess and, if needed, enhance a risk assessment tool from the VOICE trial for identifying AGYW at high risk for HIV in Lilongwe, Malawi. Methods:A multisite prospective cohort study was conducted among sexually active AGYW 15-24 years old at four health centers in 2016-2017. The VOICE tool was first applied and then updated by excluding variables that were not predictive and adding variables that were. Incidence rates (IR), incidence rate ratios (IRR), ninety-five percent confidence intervals (CIs), area under the receiver-operator characteristic curve (AUC), sensitivity, and specificity were calculated.Results: Seven-hundred ninety-five participants experienced 14 seroconversions over 672 person-years (IR: 2.08 per 100 PYs, CI: 1.23-3.52). The VOICE tool had moderate predictive ability (AUC: 0.64, CI: 0.52, 0.75). Maintaining two variables (genital ulcers and vaginal discharge), removing five socio-demographic variables, and adding two variables (ever pregnant

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

“…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).…”

“…The majority (10 of 13) were RCTs or quasi-experimental studies that restricted recruitment and/or eligibility to specific at-risk population groups: (i) sexually active, contraceptionseeking women who attended the family-planning, STIs or research clinics (7 of 10, all RCTs) [5,6,[20][21][22][23][24], or (ii) school-attending AGYW (3 of 10) [25][26][27]. The remaining three were large-scale cohort studies or community trials that recruited all consenting members within the communities [28][29][30].…”

“…This undermines the appropriateness of our pooled risk ratio estimates. In many validation studies, some selected risk factors were not available or defined differently [25, 26, 39].…”

“…405 AGYW: adolescent girls and young women the authors did re-sampling procedures through cross-validation or bootstrapping to obtain the AUC-ROC for internal validation of their score(s), and ** if they split the sample into training and testing sets as part of their internal validation); Val: external validation of the risk score in a study population different from which the score was originally developed. Peebles [6], Burgess (2018) [24] and Rosenberg [26] developed their own risk scores while also using their samples to externally validate the VOICE score developed by Balkus [5]; AUC-ROCs are provided in Table 3 [20] and Wand (2018) [21] did a random split of data sets, while Roberts [30] split the data by time periods (2012-2015 vs 2016-2019).…”

“…# Self-reported STIs histories or symptoms were used as proxies for curable STIs and HSV-2 status in Burgess (2017) [23] and Rosenberg [26], and for curable STIs in Burgess (2018) [24].…”