Moorhouse Louisa R, Gregson Simon, Imai-Eaton Jeffrey W, Mayini Justin, Dadirai Tawanda, Magoge-Mandizvidza Phyllis, Maswera Rufurwokuda, Mabaya Simbarashe, Baggaley Rachel, Low-Beer Daniel, Nyamukapa Constance, Dalal Shona
MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.
Biomedical and Research Training Institute, Harare, Zimbabwe.
medRxiv. 2024 Sep 12:2024.09.10.24312897. doi: 10.1101/2024.09.10.24312897.
Differentiating risk for HIV infection is important for providing focussed prevention options to individuals. We conducted a longitudinal study to validate a risk-differentiation tool for predicting HIV or HSV-2 acquisition among HIV-negative youth.
Population-based household survey in east Zimbabwe.
HIV and HSV-2 status and HIV behavioural risk factors were assessed in two surveys conducted 12 months apart among young people. Associations between risk-behaviours and combined HIV/HSV-2 incident infection were estimated using proportional hazards models. We calculated the sensitivity and specificity of risk-differentiation questions in predicting HIV/HSV-2 acquisition and quantified changes between surveys among low, medium, and high-risk categories.
In total, 44 HIV/HSV-2 seroconversions were observed in 1812 person-years of follow up (2.43/100PY, 95%CI: 1.71-3.15); 50% of incident cases reported never having had sex at baseline. Risk of HIV/HSV-2 acquisition was higher for those reporting non-regular partners (women: HR=2.71, 95% CI:1.12-6.54, men: HR=1.37, 95%CI: 0.29-6.38) and those reporting having a partner with a sexually transmitted infection (STI) (HR=7.62 (1.22-47.51). Adding a question on non-regular partnerships increased tool sensitivity from 18.2% to 38.6%, and further to 77.3% when restricted to those who had ever had sex. Individual risk category increased for 28% of men and 17% of women over 12-months.
The refined risk differentiation tool identified a high proportion of youth at risk of HIV acquisition. Despite this, half of incident infections were among individuals who reported no prior sexual activity. The shifting patterns of risk behaviours underscore the need for dynamic prevention engagement strategies in high HIV prevalence or incidence settings.
区分艾滋病毒感染风险对于为个人提供有针对性的预防方案很重要。我们开展了一项纵向研究，以验证一种用于预测艾滋病毒阴性青年感染艾滋病毒或单纯疱疹病毒2型（HSV-2）风险的风险区分工具。
津巴布韦东部基于人群的家庭调查。
在相隔12个月对年轻人进行的两次调查中评估艾滋病毒和HSV-2感染状况以及艾滋病毒行为风险因素。使用比例风险模型估计风险行为与艾滋病毒/HSV-2合并新发感染之间的关联。我们计算了风险区分问题在预测艾滋病毒/HSV-2感染方面的敏感性和特异性，并量化了低、中、高风险类别在两次调查之间的变化。
在1812人年的随访中总共观察到44例艾滋病毒/HSV-2血清转换（2.43/100人年，95%置信区间：1.71-3.15）；50%的新发病例报告在基线时从未有过性行为。报告有非固定性伴侣的人感染艾滋病毒/HSV-2的风险更高（女性：风险比=2.71，95%置信区间：1.12-6.54；男性：风险比=1.37，95%置信区间：0.29-6.38），报告有性传播感染（STI）伴侣的人感染风险更高（风险比=7.62（1.22-47.51）。增加一个关于非固定性伴侣关系的问题将工具的敏感性从18.2%提高到38.6%，当仅限于有过性行为的人时进一步提高到77.3%。在12个月内，28%的男性和17%的女性个体风险类别增加。
改进后的风险区分工具识别出了很大一部分有感染艾滋病毒风险的青年。尽管如此，一半的新发感染发生在报告此前没有性活动的个体中。风险行为模式的变化凸显了在艾滋病毒高流行或高发病率地区制定动态预防参与策略的必要性。
