PDF(Pubmed)
Abstract：
BACKGROUND: Clinical risk score tools require validation in diverse settings and populations before they are widely implemented. We aimed to externally validate an HIV risk assessment tool for predicting HIV acquisition among pregnant and postpartum women. In the context of prevention of mother-to-child transmission programs, risk score tools could be used to prioritize retesting efforts and delivery of pre-exposure prophylaxis (PrEP) to pregnant and postpartum women most at risk for HIV acquisition while minimizing unnecessary perinatal exposure.
METHODS: Data from women enrolled in a cross-sectional study of programmatic HIV retesting and/or receiving maternal and child health care services at five facilities in Western Kenya were used to validate the predictive ability of a simplified risk score previously developed for pregnant/postpartum women. Incident HIV infections were defined as new HIV diagnoses following confirmed negative or unknown status during pregnancy. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC) and Brier score.
RESULTS: Among 1266 women with 35 incident HIV infections, we found an AUC for predicting HIV acquisition of 0.60 (95% CI, 0.51, 0.69), with a Brier score of 0.27. A risk score >6 was associated with a 2.9-fold increase in the odds of HIV acquisition (95% CI, 1.48, 5.70; p = 0.002) vs scores ≤6. Women with risk scores >6 were 27% (346/1266) of the population but accounted for 52% of HIV acquisitions. Syphilis, age at sexual debut, and unknown partner HIV status were significantly associated with increased risk of HIV in this cohort.
CONCLUSIONS: The simplified risk score performed moderately at predicting risk of HIV acquisition in this population of pregnant and postpartum women and may be useful to guide PrEP use or counseling.
METHODS: Data from women enrolled in a cross-sectional study of programmatic HIV retesting and/or receiving maternal and child health care services at five facilities in Western Kenya were used to validate the predictive ability of a simplified risk score previously developed for pregnant/postpartum women. Incident HIV infections were defined as new HIV diagnoses following confirmed negative or unknown status during pregnancy. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC) and Brier score.
RESULTS: Among 1266 women with 35 incident HIV infections, we found an AUC for predicting HIV acquisition of 0.60 (95% CI, 0.51, 0.69), with a Brier score of 0.27. A risk score >6 was associated with a 2.9-fold increase in the odds of HIV acquisition (95% CI, 1.48, 5.70; p = 0.002) vs scores ≤6. Women with risk scores >6 were 27% (346/1266) of the population but accounted for 52% of HIV acquisitions. Syphilis, age at sexual debut, and unknown partner HIV status were significantly associated with increased risk of HIV in this cohort.
CONCLUSIONS: The simplified risk score performed moderately at predicting risk of HIV acquisition in this population of pregnant and postpartum women and may be useful to guide PrEP use or counseling.
摘要：
背景：临床风险评分工具在广泛实施之前需要在不同的环境和人群中进行验证。我们旨在从外部验证一种HIV风险评估工具，用于预测孕妇和产后妇女的HIV感染。在预防母婴传播方案的背景下，风险评分工具可用于优先对感染HIV风险最高的孕妇和产后妇女进行复检和进行暴露前预防(PrEP),同时最大限度地减少不必要的围产期暴露.
方法：在肯尼亚西部的五个机构进行了一项计划性HIV再检测和/或接受母婴保健服务的横断面研究的妇女的数据，用于验证先前为孕妇/产后妇女制定的简化风险评分的预测能力。意外HIV感染被定义为在怀孕期间确认阴性或未知状态后的新HIV诊断。使用接受者工作特征曲线下面积(AUC)和Brier评分评估预测性能。
结果：在1266名妇女中，有35例艾滋病毒感染，我们发现预测HIV感染的AUC为0.60(95%CI，0.51，0.69)，Brier得分为0.27分.风险评分>6与HIV感染几率增加2.9倍相关（95％CI，1.48，5.70；p=0.002），而评分≤6。风险评分>6的女性占人口的27％（346/1266），但占艾滋病毒感染者的52％。梅毒,初次性行为的年龄，在该队列中,未知伴侣HIV状态与HIV风险增加显著相关.
结论：简化的风险评分在预测孕妇和产后妇女感染艾滋病毒的风险方面表现适度，可能有助于指导PrEP的使用或咨询。
方法：在肯尼亚西部的五个机构进行了一项计划性HIV再检测和/或接受母婴保健服务的横断面研究的妇女的数据，用于验证先前为孕妇/产后妇女制定的简化风险评分的预测能力。意外HIV感染被定义为在怀孕期间确认阴性或未知状态后的新HIV诊断。使用接受者工作特征曲线下面积(AUC)和Brier评分评估预测性能。
结果：在1266名妇女中，有35例艾滋病毒感染，我们发现预测HIV感染的AUC为0.60(95%CI，0.51，0.69)，Brier得分为0.27分.风险评分>6与HIV感染几率增加2.9倍相关（95％CI，1.48，5.70；p=0.002），而评分≤6。风险评分>6的女性占人口的27％（346/1266），但占艾滋病毒感染者的52％。梅毒,初次性行为的年龄，在该队列中,未知伴侣HIV状态与HIV风险增加显著相关.
结论：简化的风险评分在预测孕妇和产后妇女感染艾滋病毒的风险方面表现适度，可能有助于指导PrEP的使用或咨询。
