A Four-Item Risk Score to Target Acute HIV Infection Testing Among Men Who Have Sex With Men in Indonesia:...

Area of Science:

• Epidemiology
• Public Health
• Infectious Diseases

Background:

• Indonesia faces a significant HIV epidemic, particularly among men who have sex with men (MSM).
• Early diagnosis and treatment of acute HIV infection (AHI) are crucial for individual health and reducing transmission.
• Targeted testing strategies are needed to identify individuals at highest risk for AHI.

Purpose of the Study:

• To evaluate the performance of the Amsterdam AHI risk score in Indonesian MSM.
• To develop and validate a locally optimized risk score for AHI detection in this population.

Main Methods:

• A prospective cohort study of MSM (≥16 years) in Jakarta and Bali.
• Utilized generalized estimating equation models to create a risk score combining symptoms, risk factors, and socio-demographics.
• Internal validation of the optimized score using bootstrap resampling and calculation of AUC, sensitivity, and specificity.

Main Results:

• The optimized four-item risk score achieved an AUC of 0.91, with 100% sensitivity and 65.3% specificity.
• The score identified 83.9%-100% of individuals with AHI while classifying 35.1% of MSM for further HIV-PCR testing.
• Younger MSM (16-30 years) with lower educational attainment were identified as particularly vulnerable.

Conclusions:

• A concise, four-item risk score can efficiently facilitate AHI detection in high-yield clinical settings.
• This optimized score enhances opportunities for HIV prevention among Indonesian MSM.
• The findings highlight specific socio-demographic factors associated with increased AHI vulnerability.