An HIV-1 Risk Assessment Tool for Men Aged 15–59 years in 13 African Countries: A Pooled Analysis of Nationally Representative Surveys
Year: 2025
Type: article
Abstract: BACKGROUND: Globally, approximately half of new HIV acquisitions occur among African adults. This analysis examines which cisgender men are at highest risk of acquiring HIV-1 and in greatest need of HIV pre-exposure prophylaxis (PrEP). SETTING: National population-based surveys from Eswatini, Ivory Coast, Kenya, Lesotho, Malawi, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. METHODS: The 13 surveys were pooled and sampling weights were applied to represent all susceptible men aged 15-59 years old. HIV-1 incidence was calculated based on a recent HIV-1 testing algorithm. A least absolute shrinkage and selection operator (Lasso) regression model was fit with 28 variables to predict recent HIV-1. Models were trained and internally cross-validated to estimate area under the receiver-operating characteristic curve (AUC). Along the receiver-operating characteristic curve, at sensitivity levels from 10% to 90%, performance tradeoffs were evaluated. RESULTS: Of 167,121 participants, 112 had recent HIV-1, representing 256,000 new annual infections among 122 million men. Only 2 variables were retained-reporting a male sexual partner and living in a subnational area where a high proportion of adults have detectable HIV-1 viremia. Overall AUC was 0.80 (95% Confidence Interval: 0.71 to 0.89); cross-validated AUC was 0.76 (95% CI: 0.64 to 0.87). At 10% sensitivity, 25,000 cases could be averted if 357,000 men adhered to PrEP (Number Needed to Treat = 14). At 90% sensitivity, 229,000 cases could be averted if 50 million men adhered to PrEP (Number Needed to Treat = 219). CONCLUSIONS: This predictive, parsimonious, generalizable risk assessment tool could help policymakers weigh tradeoffs between PrEP reach and efficiency.
Institutions: University of North Carolina at Chapel Hill, ICAP Global Health, Columbia University, University of Maryland, Baltimore, Human Sciences Research Council, University of Cape Town, University of Zimbabwe, Kamuzu University of Health Sciences, University of Minnesota, University of Cape Coast, Institute of Human Virology, Albert Einstein College of Medicine
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: GH15-1580 - STRENGTHENING NATIONAL EPIDEMIOLOGIC AND RESEARCH CAPACITY TO IMPROVE HEALTH OUTCOMES IN THE KINGDOM OF SWAZILAND UNDER THE PRESIDENTS EM, G2304782928, G2703992372, G2840780571, G525357486, Generalizing Effects of Infectious Disease Prevention Interventions in the Presence of Interference, G6059991683, GH15-1576, S. AFRICA, SUPPORT THE STRENGTHENING AND UTILIZATION OF STRATEGIC INFORMATION ACTIVITIES IN THE REPUBLIC OF SOUTH AFRICA UNDER THE PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF (PEPFAR), Developing a regionally representative risk assessment tool to identify men at highest risk of HIV acquisition in sub-Saharan Africa, GH15-1580, SWAZILAND: STRENGTHENING NATIONAL EPIDEMIOLOGIC AND RESEARCH CAPACITY TO IMPROVE HEALTH OUTCOMES (PEPFAR), G8654103422, G9000030772, G9000036662, G9000084668, G9000105350, G9000123515, G9000166517, G9000189641, G9000221869, G9000304941, A mentoring program for HIV prevention in pregnancy and postpartum, Central Africa International Epidemiology databases to Evaluate AIDS, Synergistic epidemics of non-communicable diseases, stigma, depression, and material insecurities among sexual and gender minorities living with HIV in Nigeria, Botswana Smoking Abstinence Reinforcement Trial (BSMART)
OpenAlex ID: W4414994856