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Identifying Adolescent Girls and Young Women at High Risk for HIV Acquisition: A Risk Assessment Tool from the Girl Power-Malawi Study

Citation

Rosenberg, Nora E.; Kudowa, Evaristar; Price, Joan T.; Pettifor, Audrey E.; Bekker, Linda-Gail; & Hosseinipour, Mina C. (2020). Identifying Adolescent Girls and Young Women at High Risk for HIV Acquisition: A Risk Assessment Tool from the Girl Power-Malawi Study. Sexually Transmitted Diseases, 47(11), 760-766. PMCID: PMC7574336

Abstract

BACKGROUND: Prioritizing HIV prevention for adolescent girls and young women (AGYW) at high risk for HIV acquisition in sub-Saharan Africa (typically considered ≥3 per 100 person-years [PYs]) is urgently needed, but identifying these AGYW is challenging. We sought to assess and, if needed, enhance a risk assessment tool from the VOICE trial for identifying AGYW at high risk for HIV in Lilongwe, Malawi.
METHODS: A multisite prospective cohort study was conducted among sexually active AGYW 15 to 24 years old at 4 health centers in 2016 to 2017. The VOICE tool was first applied and then updated by excluding variables that were not predictive and adding variables that were. Incidence rates (IRs), incidence rate ratios, 95% confidence intervals (CIs), area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated.
RESULTS: Seven hundred ninety-five participants experienced 14 seroconversions for 672 PYs (IR, 2.08 per 100 PYs; 95% CI, 1.23-3.52). The VOICE tool had moderate predictive ability (AUC, 0.64; 95% CI, 0.52-0.75). Maintaining 2 variables (genital ulcers and vaginal discharge), removing 5 sociodemographic variables, and adding 2 variables (ever pregnant and >5-year male-female age gap) enhanced performance (AUC, 0.79; 95% CI, 0.69-0.89). Thirty-five percent had a score of 0, 41% had a score of 1 to 2, and 24% had a score >3. A score >1 resulted in 100% sensitivity, 35.9% specificity, and an IR of 3.25 per 100 PYs. A score >3 resulted in 64.3% sensitivity, 76.8% specificity, and an IR of 5.89 per 100 PYs.
CONCLUSIONS: A simple risk assessment tool identified a subset of AGYW in Malawi at high risk for HIV acquisition who may benefit from biomedical HIV prevention.

URL

http://dx.doi.org/10.1097/olq.0000000000001242

Reference Type

Journal Article

Year Published

2020

Journal Title

Sexually Transmitted Diseases

Author(s)

Rosenberg, Nora E.
Kudowa, Evaristar
Price, Joan T.
Pettifor, Audrey E.
Bekker, Linda-Gail
Hosseinipour, Mina C.

PMCID

PMC7574336