title: Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States.
abstract: BACKGROUND
  To implement biomedical and other intensive HIV prevention interventions cost-effectively, busy care providers need validated, rapid, risk screening tools for identifying persons at highest risk of incident infection.
  
  
  METHODS
  To develop and validate an index, we included behavioral and HIV test data from initially HIV-uninfected men who have sex with men who reported no injection drug use during semiannual interviews in the VaxGen VAX004 study and Project Explore HIV prevention trials. Using generalized estimating equations and logistic regression analyses, we identified significant predictors of incident HIV infection, then weighted and summed their regression coefficients to create a risk index score.
  
  
  RESULTS
  The final logistic regression model included age, and the following behaviors reported during the past 6 months: total number of male sex partners, total number of HIV-positive male sex partners, number of times the participant had unprotected receptive anal sex with a male partner of any HIV status, number of times the participant had insertive anal sex with an HIV-positive male partner, whether the participant reported using poppers, and whether they reported using amphetamines. The area under the receiver operating characteristic curve was 0.74, possible scores on index range from 0 to 47 and a score ≥10 had as sensitivity of 84% and a specificity of 45%, levels appropriate for a screening tool.
  
  
  CONCLUSIONS
  We developed an easily administered and scored 7-item screening index with a cutoff that is predictive of HIV seroconversion in 2 large prospective cohorts of US men who have sex with men. The index can be used to prioritize patients for intensive HIV prevention efforts (eg, preexposure prophylaxis).
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dsmith1@cdc.gov
authors.forename: Dawn K
authors.initials: DK
authors.lastname: Smith
authors.forename: Sherri L
authors.initials: SL
authors.lastname: Pals
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Herbst
authors.forename: Sanjyot
authors.initials: S
authors.lastname: Shinde
authors.forename: James W
authors.initials: JW
authors.lastname: Carey
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003661:Decision Support Techniques; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D014481:United States; D055815:Young Adult