Use of a Risk Scoring Tool to Identify Higher-Risk HIV-1 Serodiscordant Couples for an Antiretroviral-Based HIV-1 Prevention Intervention

December 2016 - Combination Prevention

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Irungu,E.M., Heffron, R., Mugo, N., et al. BMC Infectious Diseases (2016), 16:571, doi: 10.1186/s12879-016-1899-y.

This study examined the feasibility of a validated risk screening tool to identify high-risk serodiscordant couples for enrollment in a study on pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) for HIV prevention. The risk screen assessed recent unprotected sex, number of children, marital status, circumcision status, age of the HIV-negative partner, and HIV-1 RNA levels in the HIV-positive partner. A score ≥5 (of 12 maximum) indicated high risk (>3% annual risk of HIV transmission). Of 1,013 couples, 78.6 percent scored ≥5; 76 percent were enrolled. Among those enrolled, 67 percent of the HIV-negative partners were male. Almost all (97.8%) had been married or living with their partner for an average of two and a half years, and had learned their partner's HIV-positive status within a month before participating in the screen. Over half (64.8%) reported condomless sex during the month before the screen. CD4 counts >500 were found among 41 percent of HIV-positive participants. The authors concluded that the validated screen was easy to use, low-cost, and effective at identifying high-risk couples. Counseling among serodiscordant couples should stress the benefits of early antiretroviral therapy for the HIV-negative partner.

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