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Derivation of an HIV Risk Score for African Women Who Engage in Sex Work.

Authors
  • Willcox, Alexandra C1, 2
  • Richardson, Barbra A3, 4, 5
  • Shafi, Juma6, 7
  • Kabare, Emmanuel6, 7
  • Kinuthia, John8
  • Jaoko, Walter7
  • Mandaliya, Kishorchandra4
  • Overbaugh, Julie9
  • McClelland, R Scott10, 11, 12, 13
  • 1 University of Washington School of Medicine, Seattle, WA, USA.
  • 2 Medical Scientist Training Program, University of Washington, Seattle, WA, USA.
  • 3 Department of Biostatistics, University of Washington, Seattle, WA, USA.
  • 4 Department of Global Health, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA.
  • 5 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
  • 6 Department of Medicine, University of Washington, Seattle, WA, USA.
  • 7 Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya. , (Kenya)
  • 8 Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya. , (Kenya)
  • 9 Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
  • 10 Department of Global Health, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA. [email protected]
  • 11 Department of Medicine, University of Washington, Seattle, WA, USA. [email protected]
  • 12 Department of Epidemiology, University of Washington, Seattle, WA, USA. [email protected]
  • 13 Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya. [email protected] , (Kenya)
Type
Published Article
Journal
AIDS and Behavior
Publisher
Springer-Verlag
Publication Date
Oct 01, 2021
Volume
25
Issue
10
Pages
3292–3302
Identifiers
DOI: 10.1007/s10461-021-03235-7
PMID: 33861378
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

No tool exists to stratify HIV risk in contemporary African female sex worker (FSW) populations. Data from a cohort of HIV-negative FSWs in Mombasa, Kenya from 2010 to 2017 were used to conduct a survival analysis assessing predictors of HIV infection. Stepwise regression was used to construct a multivariable model that formed the basis for the score. Seventeen HIV infections occurred over 1247 person-years of follow-up contributed by 670 women. Using depot medroxyprogesterone acetate (DMPA), having a curable sexually transmitted infection (STI), and being married contributed points to the score. HIV incidence was 0.85/100 person-years in a lower-risk group and 3.10/100 person-years in a higher-risk group. In a cohort with overall HIV incidence < 1.50/100 person-years, this risk score identified a subgroup of FSWs with HIV incidence > 3.00/100 person-years, which is the threshold used by the World Health Organization for initiating pre-exposure prophylaxis (PrEP). If validated in an external population, this tool could be useful for targeted PrEP promotion among higher-risk FSWs. © 2021. Springer Science+Business Media, LLC, part of Springer Nature.

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