Identification of adolescent girls and young women for targeted HIV prevention: a new risk scoring tool in KwaZulu Natal, South Africa

Sarah Gabrielle Ayton,Quarraisha Abdool Karim,Martina Pavlicova

doi:10.1038/s41598-020-69842-x

Abstract

The ongoing spread of human immunodeficiency virus (HIV) has driven novel interventions, such as antiretrovirals, for pre-exposure prophylaxis. Interventions have overlooked a high-risk Sub-Saharan African population: adolescent girls and young women (AGYW), particularly those under 18. We apply the Balkus risk tool among rural South African AGYW (n = 971) in a hyper-endemic setting, identify limitations, and assess deficiencies with modern statistical techniques. We apply the “Ayton” tool, the first risk tool applicable to sub-Saharan African AGYW, and compare performance of Balkus and Ayton tools under varying conditions. The Ayton tool more effectively predicted HIV acquisition. In low and high-risk AGYW, the Ayton tool out-performed the Balkus tool, which did not distinguish between risk classes. The Ayton tool better captured HIV acquisition risk and risk heterogeneities due to its AGYW-focused design. Findings support use of the Ayton tool for AGYW and underscore the need for diverse prognostic tools considering epidemic severity, age, sex and transmission.Clinical Trial Number ClinicalTrials.gov (NCT01187979) and the South African National Clinical Trials Registry (SANCTR) (DOH-27-0812-3345).

Highlights

Prognostic tools aid the identification of high-risk candidates for preventative interventions by calculating risk of health events for a given p atient[1,2,3]
Specific human immunodeficiency virus (HIV) risk tools have been developed for adult African women[4,5] and one tool has been developed for South African AGYW27
We focus on the Balkus HIV risk prediction tool[4] and the Ayton AGYW risk prediction tool[27]

Summary

Introduction

Prognostic tools aid the identification of high-risk candidates for preventative interventions by calculating risk of health events for a given p atient[1,2,3]. In high-prevalence hyper-endemic settings, such as eastern and southern Africa, adolescent girls and young women (AGYW), aged 14–25 years, are vulnerable to HIV acquisition due to power imbalance in sexual relationships[14,15,16,17,18,19], those in which HIV is acquired from men over 25 years o ld[15,18,19,20,21], and biological factors (i.e., increased genital inflammation)[18] Despite their elevated risk of infection, AGYW, those under 18 years, underutilize health services for fear of s tigmatization[18,19]. Risk predictive power was compared between the Balkus tool and the Ayton tool, and we assessed the Balkus tool’s ability to distinguish between Ayton risk classes

Methods

Results

Conclusion