A Human Immunodeficiency Virus Type 1 Risk Assessment Tool for Women Aged 15–49 Years in African Countries: A Pooled Analysis Across 15 Nationally Representative Surveys

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Abstract
Background: Women in Africa disproportionately acquire human immunodeficiency virus type 1 (HIV-1). Understanding which women are most likely to acquire HIV-1 can guide focused prevention with preexposure prophylaxis (PrEP). Our objective was to identify women at the highest risk of HIV-1 and estimate PrEP efficiency at different sensitivity levels. Methods: Nationally representative data were collected from 2015 through 2019 from 15 population-based household surveys. This analysis included women aged 15–49 who tested HIV-1 seronegative or had recent HIV-1. Least absolute shrinkage and selection operator regression models were fit with 28 variables to predict recent HIV-1. Models were trained on the full population and internally cross-validated. Performance was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, and number needed to treat (NNT) with PrEP to avert 1 infection. Results: Among 209 012 participants, 248 had recent HIV-1 infection, representing 118 million women and 402 000 (95% confidence interval [CI], 309 000–495 000) annual infections. Two variables were retained: living in a subnational area with high HIV-1 viremia and having a sexual partner living outside the home. The full-population AUC was 0.80 (95% CI, .76–.84); cross-validated AUC was 0.79 (95% CI, .75–.84). At 33% sensitivity, 130 000 cases could be averted if 7.9 million women were perfectly adherent to PrEP; NNT would be 61. At 67% sensitivity, 260 000 cases could be averted if 25.1 million women were perfectly adherent; NNT would be 96. Conclusions: This risk assessment tool was generalizable, predictive, and parsimonious with trade-offs between reach and efficiency.
Funding Information
  • National Institutes of Health (R21-MH125705, P30-AI050410, K24-AI120796, R21-MH134750, UG3-HL156389-01, U54-TW012041, UG1-HD113162, R01-HL165686, R01-AI147331, D43-TW012274, U01-CA275048, D43-TW012493, R01-HD105526, U54-CA254568, R01-AI176309, U01-AI096299)
  • Centers for Disease Control and Prevention (U2GGH001271)
  • PEPFAR (U2GGH002108)
  • ViiV Healthcare
  • Janssen
  • Sanofi
  • Novartis
  • Cepheid
  • MSD
  • FHERA

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