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AIDS Behav. 2018 Jul;22(7):2267-2276. doi: 10.1007/s10461-018-2129-y.

Risk Prediction Score for HIV Infection: Development and Internal Validation with Cross-Sectional Data from Men Who Have Sex with Men in China.

Author information

1
Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China.
2
Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
3
Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China.
4
Departments of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
5
Chaoyang District Center for Disease Control and Prevention, Beijing, China.
6
Xicheng District Center for Disease Control and Prevention, Beijing, China.
7
State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
8
Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
9
Department of Child, Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing, China.
10
School of Public Health, Sun Yat-sen University, Guangzhou, China.
11
Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA. sten.vermund@yale.edu.
12
Yale School of Public Health, Yale University, New Haven, CT, USA. sten.vermund@yale.edu.
13
Yale School of Public Health, Yale University, New Haven, CT, USA.

Abstract

Receptive anal intercourse, multiple partners, condomless sex, sexually transmitted infections (STIs), and drug/alcohol addiction are familiar factors that correlate with increased human immunodeficiency virus (HIV) risk among men who have sex with men (MSM). To improve estimation to HIV acquisition, we created a composite score using questions from routine survey of 3588 MSM in Beijing, China. The HIV prevalence was 13.4%. A risk scoring tool using penalized maximum likelihood multivariable logistic regression modeling was developed, deploying backward step-down variable selection to obtain a reduced-form model. The full penalized model included 19 sexual predictors, while the reduced-form model had 12 predictors. Both models calibrated well; bootstrap-corrected c-indices were 0.70 (full model) and 0.71 (reduced-form model). Non-Beijing residence, short-term living in Beijing, illegal drug use, multiple male sexual partners, receptive anal sex, inconsistent condom use, alcohol consumption before sex, and syphilis infection were the strongest predictors of HIV infection. Discriminating higher-risk MSM for targeted HIV prevention programming using a validated risk score could improve the efficiency of resource deployment for educational and risk reduction programs. A valid risk score can also identify higher risk persons into prevention and vaccine clinical trials, which would improve trial cost-efficiency.

KEYWORDS:

China; HIV; HIV prevention; Men who have sex with men (MSM); Risk score

PMID:
29786768
DOI:
10.1007/s10461-018-2129-y

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