Abstract
BackgroundAntiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) reduce HIV-1 transmission within heterosexual HIV-1 serodiscordant couples. Prioritizing couples at highest HIV-1 transmission risk for ART and PrEP would maximize impact and minimize costs.MethodsThe Partners Demonstration Project is an open-label, delivery study of integrated PrEP and ART for HIV-1 prevention among high risk HIV-1 serodiscordant couples in Kenya and Uganda. We evaluated the feasibility of using a validated risk score that weighs a combination of easily measurable factors (age, children, marital status, male circumcision status, condom use, plasma HIV-1 levels) to identify couples at highest risk for HIV-1 transmission for enrollment. Couples scoring ≥5 met the risk score eligibility criteria.ResultsWe screened 1694 HIV-1 serodiscordant couples and enrolled 1013. Of the screened couples, 1331 (78.6 %) scored ≥5 (with an expected incidence >3 % per year) and 76 % of these entered the study. The median age of the HIV-1 uninfected partner was 29 years [IQR 26, 36] and 20 % were <25 years of age. The HIV-1 uninfected partner was male in 67 % of partnerships, 33 % of whom were uncircumcised, 57 % of couples had no children, and 65 % reported unprotected sex in the month prior to enrollment. Among HIV-1 infected partners, 41 % had plasma viral load >50,000 copies/ml.ConclusionA risk scoring tool identified HIV-1 serodiscordant couples for a demonstration project of PrEP and ART with high HIV-1 risk. The tool may be feasible for research and public health settings to maximize efficiency and minimize HIV-1 prevention costs.
Highlights
Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) reduce HIV-1 transmission within heterosexual HIV-1 serodiscordant couples
We previously developed and validated an empiric risk scoring tool to identify highest-risk HIV-1 serodiscordant African heterosexual couples using data from 8500 stable HIV-1 serodiscordant African couples enrolled in three prospective studies [10]
The score is composed of variables that are measurable in clinical settings including whether the couple had any unprotected sex in the prior month, the number of children in the partnership, marital status, age of the HIV-1 uninfected partner, circumcision status of HIV-1 uninfected male partners, and plasma HIV-1 RNA concentrations in the HIV-1 infected partner (Fig. 1)
Summary
Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) reduce HIV-1 transmission within heterosexual HIV-1 serodiscordant couples. The score is composed of variables that are measurable in clinical settings including whether the couple had any unprotected sex in the prior month, the number of children in the partnership, marital status, age of the HIV-1 uninfected partner, circumcision status of HIV-1 uninfected male partners, and plasma HIV-1 RNA concentrations in the HIV-1 infected partner (Fig. 1). Additional variables such as gender, duration of partnership, hormonal contraception use and CD4 count were considered for the scoring tool but these were less predictive of HIV-1 transmission risk than the included factors. We assessed the ability of the HIV-1 risk score to identify higher-risk HIV1 serodiscordant couples for recruitment into a prospective study delivering ART and PrEP for HIV-1 prevention in Kenya and Uganda
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