Prediction of HIV Acquisition Among Men Who Have Sex With Men

Abstract

Objective To develop and validate an easy-to-use prediction model for HIV acquisition among men who have sex with men (MSM). Methods We developed prediction models using medical records data from an STD clinic (2001–2008) and validated these models using data from the control arm of Project Explore, an HIV prevention trial (1999–2003). Results Of 1903 MSM who tested for HIV more than once in the development sample, 101 acquired HIV over 6.7 years of follow-up. Annual HIV incidence was 2.57% (95% confidence interval [CI]: 2.09%, 3.12%). During 4 years of follow-up of 2081 Project Explore control arm participants, 144 acquired HIV for an incidence of 2.32% (95%CI: 1.96%, 2.73%). A prediction model that included variables indicating use of methamphetamine or inhaled nitrites in the prior 6 months, unprotected anal intercourse with a partner of positive or unknown HIV status in the prior year, ≥10 male sex partners in the prior year, and current diagnosis or history of bacterial sexually transmitted infection was well calibrated overall (expected-observed ratio = 1.01; 95%CI: 0.97, 1.05) and had modest discriminatory accuracy at 1 year (area under the receiver-operator characteristic curve [AUC]=0.67; 95%CI: 0.60, 0.75) and at 4 years (AUC=0.66; 95%CI: 0.61, 0.71). Over four years, cumulative incidence ranged from 3.9% to 14.3% for groups of men defined by the prediction model. Conclusions A new risk score was predictive of HIV acquisition and could assist providers in counseling MSM and in targeting intensified prevention to MSM at greatest risk for HIV infection. Its accuracy requires further evaluation.

Barriers to HIV Care and Treatment Among Participants in a Public Health HIV Care Relinkage Program

“…Studies of medication-assisted therapy to reduce methamphetamine use have, to date, mostly been negative, apart from one study of mirtazapine. 23 The proportionately greater methamphetamine use among referred participants, who were identified primarily through the STD Clinic and STD partner services, likely reflects the higher HIV/STD transmission risk among methamphetamine-using MSM 24,25 and further highlights the public health challenge of addressing methamphetamine as a barrier to HIV care and treatment and as a facilitator of HIV transmission. Many substance users did not identify their substance use as an important barrier to care.…”

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…International guidance on testing frequency from Australia (221) (234) and the USA (235) use a number of observational studies including a weighted risk assessment (236) to guide recommendations on more frequent testing in men at 'high risk' who have greater partner numbers or a history of recreational drugs use. BASHH Recommendations for Testing for Sexually Transmitted Infections in Men-who have sex-with-men 2014, derived from an expert consensus meeting in 2014 (76) suggest a much broader interpretation of MSM at 'high risk' to include any unprotected sexual contact (oral, genital or anal) with a new partner.…”

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

“…Other tools developed for use in sexual health have achieved similar levels of performance in, for example, identifying patients at risk for chlamydia and/or gonorrhoea (AUROC curve = 0.74) 64 and identifying MSM at risk for HIV acquisition (AUROC curve = 0.67). 75 It was suggested that having children may be more likely to affect attendance among women than men and, indeed, the gender variable was excluded from the model when having children was introduced. However, univariable analysis indicated that there was a significant effect for being a mother or a father compared with having no children and this variable did not provide any additional explanatory value when incorporated into the model instead of the binary variable.…”