Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
Department of Biostatistics, Columbia University Mailman School of Public Health, New York City, New York, USA.
Sex Transm Infect. 2020 Feb;96(1):47-54. doi: 10.1136/sextrans-2019-054067. Epub 2019 Jul 20.
Adolescent females in sub-Saharan Africa bear a disproportionate burden of new HIV infections but have been excluded from prognostic research, such as developed risk calculators. This study examines whether validated risk calculators, which calculate HIV risk among sub-Saharan African women, can be modified to assess HIV risk among adolescent girls. The performance of selected risk variables from validated calculators and the literature was evaluated among adolescent females using modern advanced statistical tools.
Risk variables for the updated tool were selected from the CAPRISA 007 (CAP007) trial (2010-2012) questionnaires. An initially HIV-seronegative cohort of rural South African female high school students (n=1049) aged 14-25 years was selected. The number and characteristics of latent factors, or dimensions, underlying selected variables were assessed using exploratory factor analysis (EFA). The updated tool's effectiveness identifying trends in adolescent risk were assessed with latent class analysis (LCA).
EFA identified two key latent factors: sexual behaviour and socioeconomic risk factors. Latent sexual behaviour risk influenced contraception use (0.883), perceived HIV risk (0.691) and pregnancy (-0.384). Latent socioeconomic risk influenced low HIV knowledge (0.371), financial dependence (0.532), prior HIV testing (-0.379) and alcohol use (-0.332). Using LCA, three underlying categories of adolescent females were identified: those with no, low and high risk of HIV (1.10%, 2.26% and 2.91% 1-year seroconversion rates, respectively). Herpes simplex virus serotype-2, condom contraception, alcohol use, pregnancy and age were significantly associated with higher risk class membership, while non-condom contraception was associated with lower risk class membership.
Adolescent females are at unequal risk of acquiring HIV. Findings suggest the updated tool captures two main facets of adolescent characteristics and may identify differential risk. This work supports further investigation to inform development of targeted differentiated interventions and efficient prognostic tools for adolescents in high-risk settings.
撒哈拉以南非洲的青春期女性承担了不成比例的新 HIV 感染负担，但她们被排除在预后研究之外，例如已开发的风险计算器。本研究检查了经过验证的风险计算器（用于计算撒哈拉以南非洲女性的 HIV 风险）是否可以修改，以评估青春期少女的 HIV 风险。使用现代先进的统计工具，评估了从经过验证的计算器和文献中选择的选定风险变量在青春期女性中的表现。
从 CAPRISA 007（CAP007）试验（2010-2012 年）问卷中选择更新工具的风险变量。选择了南非农村地区的初始 HIV 血清阴性的女高中生队列（n=1049），年龄在 14-25 岁之间。使用探索性因素分析（EFA）评估选定变量潜在因素或维度的数量和特征。使用潜在类别分析（LCA）评估更新工具识别青少年风险趋势的有效性。
EFA 确定了两个关键的潜在因素：性行为和社会经济风险因素。潜在的性行为风险影响了避孕措施的使用（0.883）、感知的 HIV 风险（0.691）和怀孕（-0.384）。潜在的社会经济风险影响了 HIV 知识水平低（0.371）、经济依赖（0.532）、先前的 HIV 检测（-0.379）和饮酒（-0.332）。使用 LCA，确定了三种潜在的青春期女性类别：无 HIV 风险（1.10%，1 年血清转化率）、低风险（2.26%）和高风险（2.91%）。单纯疱疹病毒 2 型、 condom 避孕、饮酒、怀孕和年龄与更高的风险类别成员显著相关，而非 condom 避孕与较低的风险类别成员相关。
青春期女性感染 HIV 的风险不平等。研究结果表明，更新后的工具捕捉到了青春期特征的两个主要方面，并且可能识别出不同的风险。这项工作支持进一步的研究，以制定有针对性的差异化干预措施，并为高风险环境中的青少年提供有效的预后工具。
