Open AccessDerivation of an HIV Risk Score for African Women Who Engage in Sex Work
Author(s) -
Alexandra C Willcox,
Barbra A. Richardson,
Juma Shafi,
Emmanuel Kabare,
John Kinuthia,
Walter Jaoko,
Kishorchandra Mandaliya,
Julie Overbaugh,
R. Scott McClelland
Publication year - 2021
Publication title -
aids and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.994
H-Index - 106
eISSN - 1573-3254
pISSN - 1090-7165
DOI - 10.1007/s10461-021-03235-7
Subject(s) - medicine , demography , incidence (geometry) , cohort , health psychology , public health , population , human immunodeficiency virus (hiv) , cohort study , sex work , gynecology , gerontology , environmental health , immunology , nursing , physics , sociology , optics
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.