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An Empiric Risk Score to Guide PrEP Targeting Among MSM in Coastal Kenya

Elizabeth Wahome1, Alexander N Thiong'o2, Grace Mwashigadi3

  • 1KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, Kilifi, Kenya. ewahome@kemri-wellcome.org.

AIDS and Behavior
|May 17, 2018
PubMed

Insights

A new risk score can identify high-risk men who have sex with men (MSM) for HIV pre-exposure prophylaxis (PrEP) in Kenya. This tool helps target PrEP delivery to MSM with the greatest need, improving prevention efforts.

Area of Science:

  • Public Health
  • Epidemiology
  • HIV Prevention

Background:

  • Kenyan pre-exposure prophylaxis (PrEP) guidelines do not specifically target men who have sex with men (MSM) with varying HIV risks.
  • Targeted PrEP delivery is crucial for effective HIV prevention among MSM.

Purpose of the Study:

  • To develop an empiric risk score for identifying high-risk MSM for PrEP delivery in Kenya.
  • To improve the targeting of PrEP interventions within the MSM community.

Main Methods:

  • Data from an open cohort of 753 HIV-negative MSM followed for over 1378.5 person-years were analyzed.
  • A Poisson model identified independent predictors of incident HIV-1 infection.
  • Predictor coefficients were used to create a numeric risk score.

Main Results:

  • Key predictors of HIV-1 infection included age (18-24 years), exclusively male partners, receptive anal intercourse, unprotected sex, and group sex.
  • A risk score of ≥1 identified 81.3% of participants as high-risk, with an HIV-1 incidence of ≥2.2 (95% CI 1.2-4.1).
  • The model achieved an area under the receiver operating characteristic curve of 0.76 (95% CI 0.71-0.80).

Conclusions:

  • An empiric risk score can effectively identify MSM at high risk of HIV-1 acquisition in Kenya.
  • This tool can aid Kenyan healthcare providers in assessing risk and encouraging PrEP uptake among high-risk MSM.
  • Improved risk assessment can optimize PrEP resource allocation and enhance HIV prevention strategies.
Keywords:
HIV-1 acquisitionKenyaMSMPrEPRisk score

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