University of Washington School of Medicine, Seattle, WA, USA.
Medical Scientist Training Program, University of Washington, Seattle, WA, USA.
AIDS Behav. 2021 Oct;25(10):3292-3302. doi: 10.1007/s10461-021-03235-7. Epub 2021 Apr 16.
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.
目前尚无工具可用于对当代非洲女性性工作者（FSW）人群进行 HIV 风险分层。本研究使用了来自肯尼亚蒙巴萨 2010 至 2017 年 HIV 阴性 FSW 队列的数据，对 HIV 感染的预测因素进行了生存分析。逐步回归用于构建多变量模型，该模型是评分的基础。在由 670 名女性贡献的 1247 人年随访中，发生了 17 例 HIV 感染。使用长效醋酸甲羟孕酮（DMPA）、患有可治愈的性传播感染（STI）和已婚会给评分加分。低风险组的 HIV 发病率为 0.85/100 人年，高风险组为 3.10/100 人年。在 HIV 总发病率<1.50/100 人年的队列中，该风险评分确定了 HIV 发病率>3.00/100 人年的 FSW 亚组，这是世界卫生组织启动暴露前预防（PrEP）的阈值。如果在外部人群中得到验证，该工具可用于针对高风险 FSW 进行有针对性的 PrEP 推广。
