Derivation of an HIV Risk Score for African Women Who Engage in Sex Work

Alexandra C Willcox; Barbra A Richardson; Juma Shafi; Emmanuel Kabare; John Kinuthia; Walter Jaoko; Kishorchandra Mandaliya; Julie Overbaugh; R Scott McClelland

doi:10.1007/s10461-021-03235-7

Derivation of an HIV Risk Score for African Women Who Engage in Sex Work

AIDS Behav. 2021 Oct;25(10):3292-3302. doi: 10.1007/s10461-021-03235-7. Epub 2021 Apr 16.

Authors

Alexandra C Willcox^{1

2}, Barbra A Richardson^{3

4

5}, Juma Shafi^{6

7}, Emmanuel Kabare^{6

7}, John Kinuthia⁸, Walter Jaoko⁷, Kishorchandra Mandaliya⁴, Julie Overbaugh⁹, R Scott McClelland^{10

11

12

13}

Affiliations

¹ University of Washington School of Medicine, Seattle, WA, USA.
² Medical Scientist Training Program, University of Washington, Seattle, WA, USA.
³ Department of Biostatistics, University of Washington, Seattle, WA, USA.
⁴ Department of Global Health, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA.
⁵ Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
⁶ Department of Medicine, University of Washington, Seattle, WA, USA.
⁷ Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
⁸ Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya.
⁹ Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
¹⁰ Department of Global Health, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA. mcclell@uw.edu.
¹¹ Department of Medicine, University of Washington, Seattle, WA, USA. mcclell@uw.edu.
¹² Department of Epidemiology, University of Washington, Seattle, WA, USA. mcclell@uw.edu.
¹³ Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya. mcclell@uw.edu.

Abstract

No tool exists to stratify HIV risk in contemporary African female sex worker (FSW) populations. Data from a cohort of HIV-negative FSWs in Mombasa, Kenya from 2010 to 2017 were used to conduct a survival analysis assessing predictors of HIV infection. Stepwise regression was used to construct a multivariable model that formed the basis for the score. Seventeen HIV infections occurred over 1247 person-years of follow-up contributed by 670 women. Using depot medroxyprogesterone acetate (DMPA), having a curable sexually transmitted infection (STI), and being married contributed points to the score. HIV incidence was 0.85/100 person-years in a lower-risk group and 3.10/100 person-years in a higher-risk group. In a cohort with overall HIV incidence < 1.50/100 person-years, this risk score identified a subgroup of FSWs with HIV incidence > 3.00/100 person-years, which is the threshold used by the World Health Organization for initiating pre-exposure prophylaxis (PrEP). If validated in an external population, this tool could be useful for targeted PrEP promotion among higher-risk FSWs.

Keywords: Africa; Female sex workers; HIV; Kenya; Risk score.

MeSH terms

Female
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Humans
Incidence
Kenya / epidemiology
Pre-Exposure Prophylaxis*
Risk Factors
Sex Work
Sex Workers*

Abstract

MeSH terms

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