A Human Immunodeficiency Virus Type 1 Risk Assessment Tool for Women Aged 15–49 Years in African Countries: A Pooled Analysis Across 15 Nationally Representative Surveys
Nora E. Rosenberg, Bonnie E. Shook‐Sa, Amber Young, Yating Zou, Lynda Stranix‐Chibanda, Marcel Yotebieng, Nadia A. Sam‐Agudu, Sam Phiri, Wilbroad Mutale, Linda‐Gail Bekker, Manhattan Charurat, Sizulu Moyo, Khangelani Zuma, Jessica Justman, Michael G. Hudgens, H. Benjamin
Abstract
BACKGROUND: Women in Africa disproportionately acquire human immunodeficiency virus type 1 (HIV-1). Understanding which women are most likely to acquire HIV-1 can guide focused prevention with preexposure prophylaxis (PrEP). Our objective was to identify women at the highest risk of HIV-1 and estimate PrEP efficiency at different sensitivity levels. METHODS: Nationally representative data were collected from 2015 through 2019 from 15 population-based household surveys. This analysis included women aged 15-49 who tested HIV-1 seronegative or had recent HIV-1. Least absolute shrinkage and selection operator regression models were fit with 28 variables to predict recent HIV-1. Models were trained on the full population and internally cross-validated. Performance was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, and number needed to treat (NNT) with PrEP to avert 1 infection. RESULTS: Among 209 012 participants, 248 had recent HIV-1 infection, representing 118 million women and 402 000 (95% confidence interval [CI], 309 000-495 000) annual infections. Two variables were retained: living in a subnational area with high HIV-1 viremia and having a sexual partner living outside the home. The full-population AUC was 0.80 (95% CI, .76-.84); cross-validated AUC was 0.79 (95% CI, .75-.84). At 33% sensitivity, 130 000 cases could be averted if 7.9 million women were perfectly adherent to PrEP; NNT would be 61. At 67% sensitivity, 260 000 cases could be averted if 25.1 million women were perfectly adherent; NNT would be 96. CONCLUSIONS: This risk assessment tool was generalizable, predictive, and parsimonious with trade-offs between reach and efficiency.