Mailman School of Public Health, Columbia University, 722 W. 168th Street, 6th floor, Rm. 635, New York, NY, 10032, USA.
Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico.
Sci Rep. 2020 Aug 3;10(1):13017. doi: 10.1038/s41598-020-69842-x.
The ongoing spread of human immunodeficiency virus (HIV) has driven novel interventions, such as antiretrovirals, for pre-exposure prophylaxis. Interventions have overlooked a high-risk Sub-Saharan African population: adolescent girls and young women (AGYW), particularly those under 18. We apply the Balkus risk tool among rural South African AGYW (n = 971) in a hyper-endemic setting, identify limitations, and assess deficiencies with modern statistical techniques. We apply the "Ayton" tool, the first risk tool applicable to sub-Saharan African AGYW, and compare performance of Balkus and Ayton tools under varying conditions. The Ayton tool more effectively predicted HIV acquisition. In low and high-risk AGYW, the Ayton tool out-performed the Balkus tool, which did not distinguish between risk classes. The Ayton tool better captured HIV acquisition risk and risk heterogeneities due to its AGYW-focused design. Findings support use of the Ayton tool for AGYW and underscore the need for diverse prognostic tools considering epidemic severity, age, sex and transmission.Clinical Trial Number ClinicalTrials.gov (NCT01187979) and the South African National Clinical Trials Registry (SANCTR) (DOH-27-0812-3345).
人类免疫缺陷病毒 (HIV) 的持续传播推动了新的干预措施，如抗逆转录病毒药物，用于暴露前预防。这些干预措施忽视了一个高风险的撒哈拉以南非洲人群：青少年女孩和年轻妇女（AGYW），特别是 18 岁以下的 AGYW。我们在一个高度流行的环境中对南非农村地区的 AGYW（n = 971）应用 Balkus 风险工具，确定了局限性，并使用现代统计技术评估了不足。我们应用了适用于撒哈拉以南非洲 AGYW 的第一个风险工具 "Ayton" 工具，并比较了 Balkus 和 Ayton 工具在不同条件下的性能。Ayton 工具更有效地预测了 HIV 的获得。在低风险和高风险的 AGYW 中，Ayton 工具的表现优于 Balkus 工具，后者无法区分风险类别。由于 Ayton 工具专注于 AGYW 的设计，因此它更好地捕捉了 HIV 获得风险和风险异质性。这些发现支持在 AGYW 中使用 Ayton 工具，并强调需要考虑到流行严重程度、年龄、性别和传播方式的多样化预后工具。临床试验编号 ClinicalTrials.gov（NCT01187979）和南非国家临床试验登记处（SANCTR）（DOH-27-0812-3345）。
