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Predicting the risk of HIV infection among internal migrant MSM in China: An optimal model based on three variable
Shangbin Liu1, Danni Xia1, Yuxuan Wang1
1School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Introduction:
Internal migrant Men who have sex with men (IMMSM), which has the dual identity of MSM and floating population, should be more concerned among the vulnerable groups for HIV in society. Establishing appropriate prediction models to assess the risk of HIV infection among IMMSM is of great significance to against HIV infection and transmission.
Methods:
HIV and syphilis infection were detected using rapid test kits, and other 30 variables were collected among IMMSM through questionnaire. Taking HIV infection status as the dependent variable, three methods were used to screen predictors and three prediction models were developed respectively. The Hosmer-Lemeshow test was performed to verify the fit of the models, and the net classification improvement and integrated discrimination improvement were used to compare these models to determine the optimal model. Based on the optimal model, a prediction nomogram was developed as an instrument to assess the risk of HIV infection among IMMSM. To quantify the predictive ability of the nomogram, the C-index measurement was performed, and internal validation was performed using bootstrap method. The receiver operating characteristic (ROC) curve, calibration plot and dynamic component analysis (DCA) were respectively performed to assess the efficacy, accuracy and clinical utility of the prediction nomogram.
Results:
In this study, 12.52% IMMSMs were tested HIV-positive and 8.0% IMMSMs were tested syphilis-positive. Model A, model B, and model C fitted well, and model B was the optimal model. A nomogram was developed based on the model B. The C-index of the nomogram was 0.757 (95% CI: 0.701-0.812), and the C-index of internal verification was 0.705.
Conclusions:
The model established by stepwise selection methods incorporating 11 risk factors (age, education, marriage, monthly income, verbal violence, syphilis, score of CUSS, score of RSES, score of ULS, score of ES and score of DS) was the optimal model that achieved the best predictive power. The risk nomogram based on the optimal model had relatively good efficacy, accuracy and clinical utility in identifying internal migrant MSM at high-risk for HIV infection, which is helpful for developing targeted intervention for them.
Insights
A new prediction model and nomogram can identify internal migrant men who have sex with men (IMMSM) at high risk for HIV infection. This tool aids in developing targeted interventions for this vulnerable population.
Area of Science:
- Epidemiology
- Public Health
- Biostatistics
Background:
- Internal migrant men who have sex with men (IMMSM) are a vulnerable population for HIV infection.
- Effective prediction models are crucial for assessing and mitigating HIV risk in IMMSM.
Purpose of the Study:
- To develop and validate a prediction model and nomogram to assess HIV infection risk among IMMSM.
- To identify key risk factors associated with HIV infection in this population.
Main Methods:
- Three prediction models were developed using logistic regression and stepwise selection.
- Model performance was assessed using Hosmer-Lemeshow tests, classification improvements, and C-index.
- A nomogram was constructed based on the optimal model and internally validated using bootstrap methods.
Main Results:
- The optimal model incorporated 11 risk factors, including age, syphilis, and various psychological scores.
- The developed nomogram demonstrated good predictive ability with a C-index of 0.757 (internal validation: 0.705).
- 12.52% of IMMSM tested HIV-positive and 8.0% tested syphilis-positive.
Conclusions:
- The risk nomogram is effective, accurate, and clinically useful for identifying IMMSM at high risk for HIV infection.
- The findings support the development of targeted interventions to reduce HIV transmission in this population.
