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Muttai H, Guyah B, Musingila P, Achia T, Miruka F, Wanjohi S, Dande C, Musee P, Lugalia F, Onyango D, Kinywa E, Okomo G, Moth I, Omondi S, Ayieko C, Nganga L, Joseph RH, Zielinski-Gutierrez E. Development and Validation of a Sociodemographic and Behavioral Characteristics-Based Risk-Score Algorithm for Targeting HIV Testing Among Adults in Kenya. AIDS Behav 2021; 25:297-310. [PMID: 32651762 PMCID: PMC7846530 DOI: 10.1007/s10461-020-02962-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To inform targeted HIV testing, we developed and externally validated a risk-score algorithm that incorporated behavioral characteristics. Outpatient data from five health facilities in western Kenya, comprising 19,458 adults ≥ 15 years tested for HIV from September 2017 to May 2018, were included in univariable and multivariable analyses used for algorithm development. Data for 11,330 adults attending one high-volume facility were used for validation. Using the final algorithm, patients were grouped into four risk-score categories: ≤ 9, 10-15, 16-29 and ≥ 30, with increasing HIV prevalence of 0.6% [95% confidence interval (CI) 0.46-0.75], 1.35% (95% CI 0.85-1.84), 2.65% (95% CI 1.8-3.51), and 15.15% (95% CI 9.03-21.27), respectively. The algorithm's discrimination performance was modest, with an area under the receiver-operating-curve of 0.69 (95% CI 0.53-0.84). In settings where universal testing is not feasible, a risk-score algorithm can identify sub-populations with higher HIV-risk to be prioritized for HIV testing.
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Affiliation(s)
- Hellen Muttai
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya.
| | - Bernard Guyah
- School of Public Health, Maseno University, Kisumu, Kenya
| | - Paul Musingila
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Thomas Achia
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Fredrick Miruka
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | | | - Caroline Dande
- University of California at San Francisco, Kisumu, Kenya
| | - Polycarp Musee
- Elizabeth Glaser Pediatric AIDS Foundation, Homa Bay, Kenya
| | | | | | | | - Gordon Okomo
- Homa Bay County Department of Health, Homa Bay, Kenya
| | - Iscah Moth
- Homa Bay County Department of Health, Homa Bay, Kenya
| | | | | | - Lucy Nganga
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Rachael H Joseph
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Emily Zielinski-Gutierrez
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
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Williams CM, McCloskey LA, Larsen U. Sexual violence at first intercourse against women in Moshi, northern Tanzania: prevalence, risk factors, and consequences. Population Studies 2009; 62:335-48. [PMID: 18937146 DOI: 10.1080/00324720802315459] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To explore the relationship between sexual violence at first intercourse and later sexually transmitted infections (STIs) in Moshi, Tanzania, we analysed data from a representative household survey that comprised face-to-face interviews with 1,835 women and tests for six STIs on biological samples from 1,235 of these women. Overall, 10.9 per cent report forced first intercourse and 15.3 per cent report unwanted first intercourse. Unadjusted analysis shows a relationship between forced first intercourse and STIs (OR: 1.72, 95 per cent CI: 1.19-2.51). Life-course variables mediate this relationship. Significant predictors of having an STI include older age, more sexual partners, and a partner who has children with other women. Coerced first intercourse appears to be associated with changes in the life course of women and with a heightened risk of contracting an STI.
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Chen L, Jha P, Stirling B, Sgaier SK, Daid T, Kaul R, Nagelkerke N. Sexual risk factors for HIV infection in early and advanced HIV epidemics in sub-Saharan Africa: systematic overview of 68 epidemiological studies. PLoS One 2007; 2:e1001. [PMID: 17912340 PMCID: PMC1994584 DOI: 10.1371/journal.pone.0001001] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 09/03/2007] [Indexed: 02/06/2023] Open
Abstract
Background It is commonly assumed that sexual risk factors for heterosexual HIV transmission in sub-Saharan Africa, such as multi-partner sex, paid sex and co-infections, become less important as HIV epidemics mature and prevalence increases. Methods and Findings We conducted a systematic review of 68 African epidemiological studies from 1986 to 2006 involving 17,000 HIV positive adults and 73,000 controls. We used random-effects methods and stratified results by gender, time, background HIV prevalence rates and other variables. The number of sex partners, history of paid sex, and infection with herpes simplex virus (HSV-2) or other sexually-transmitted infections (STIs) each showed significant associations with HIV infection. Among the general population, the odds ratio (OR) of HIV infection for women reporting 3+ sex partners versus 0–2 was 3.64 (95%CI [2.87–4.62]), with similar risks for men. About 9% of infected women reported ever having been paid for sex, versus 4% of control women (OR = 2.29, [1.45–3.62]). About 31% of infected men reported ever paying for sex versus 18% of uninfected men (OR = 1.75, [1.30–2.36]). HSV-2 infection carried the largest risk of HIV infection: OR = 4.62, [2.85–7.47] in women, and OR = 6.97, [4.68–10.38] in men. These risks changed little over time and stratification by lower and higher HIV background prevalence showed that risk ratios for most variables were larger in high prevalence settings. Among uninfected controls, the male-female differences in the number of sex partners and in paid sex were more extreme in the higher HIV prevalence settings than in the lower prevalence settings. Significance Multi-partner sex, paid sex, STIs and HSV-2 infection are as important to HIV transmission in advanced as in early HIV epidemics. Even in high prevalence settings, prevention among people with high rates of partner change, such as female sex workers and their male clients, is likely to reduce transmission overall.
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Affiliation(s)
- Li Chen
- Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Prabhat Jha
- Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- * To whom correspondence should be addressed. E-mail:
| | - Bridget Stirling
- Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Sciences, Island Medical Program, University of Victoria, Victoria, British Columbia, Canada
| | - Sema K. Sgaier
- Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tina Daid
- Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nico Nagelkerke
- Department of Community Medicine, Al Ain University, Al Ain, United Arab Emirates
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