Indices to measure risk of HIV acquisition in Rakai, Uganda.
Indices to measure risk of HIV acquisition in Rakai, Uganda.
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DOI：
10.1371/journal.pone.0092015
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Singer ME
中科院分区：
文献类型：
--
作者：
Kagaayi J;Gray RH;Whalen C;Fu P;Neuhauser D;McGrath JW;Sewankambo NK;Serwadda D;Kigozi G;Nalugoda F;Reynolds SJ;Wawer MJ;Singer ME
针对高危人群实施艾滋病毒预防干预措施具有成本效益。我们制定了针对性别的指数来衡量乌干达拉凯性活跃个体感染艾滋病毒的风险。我们使用多变量 Cox 比例风险模型来估计与候选预测因子相关的 HIV 感染时间。使用后向选择程序以 Akaike 信息准则 (AIC) 作为停止规则来确定简化模型。使用 Harrell 一致性指数（c 指数）确定模型歧视。模型校准以图形方式确定。列线图用于呈现最终的预测模型。我们使用了 7,497 名女性和 5,783 名男性的样本。女性新增感染病例 342 例（发病率为 1.11/100 人年），男性新增感染病例 225 例（发病率为 1.00/100 人年）。男性的最终模型包括年龄、教育程度、包皮环切状况、性伴侣数量、生殖器溃疡病症状、性行为前饮酒、高风险职业伴侣、社区类型、不了解伴侣的艾滋病毒状况和社区艾滋病毒患病率。该模型的乐观校正 c 指数为 69.1% (95% CI = 0.66, 0.73)。最终的女性模型包括年龄、婚姻状况、教育程度、性伴侣数量、新性伴侣、性行为前自己或伴侣饮酒量、同时性伴侣、从事高危职业、患有生殖器溃疡病症状、社区艾滋病毒感染率以及认为自己或伴侣接触艾滋病毒。模型乐观校正 c 指数为 0.67 (95% CI = 0.64, 0.70)。两种模型都经过良好校准。这些指数具有区分性并且经过良好校准。这提供了可以开发基于人群的艾滋病毒风险指数的概念验证。需要进一步研究以验证其他人群的这些指数。
Targeting most-at-risk individuals with HIV preventive interventions is cost-effective. We developed gender-specific indices to measure risk of HIV among sexually active individuals in Rakai, Uganda. We used multivariable Cox proportional hazards models to estimate time-to-HIV infection associated with candidate predictors. Reduced models were determined using backward selection procedures with Akaike's information criterion (AIC) as the stopping rule. Model discrimination was determined using Harrell's concordance index (c index). Model calibration was determined graphically. Nomograms were used to present the final prediction models. We used samples of 7,497 women and 5,783 men. 342 new infections occurred among females (incidence 1.11/100 person years,) and 225 among the males (incidence 1.00/100 person years). The final model for men included age, education, circumcision status, number of sexual partners, genital ulcer disease symptoms, alcohol use before sex, partner in high risk employment, community type, being unaware of a partner's HIV status and community HIV prevalence. The Model's optimism-corrected c index was 69.1 percent (95% CI = 0.66, 0.73). The final women's model included age, marital status, education, number of sex partners, new sex partner, alcohol consumption by self or partner before sex, concurrent sexual partners, being employed in a high-risk occupation, having genital ulcer disease symptoms, community HIV prevalence, and perceiving oneself or partner to be exposed to HIV. The models optimism-corrected c index was 0.67 (95% CI = 0.64, 0.70). Both models were well calibrated. These indices were discriminative and well calibrated. This provides proof-of-concept that population-based HIV risk indices can be developed. Further research to validate these indices for other populations is needed.
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