title: Risk Factors for HIV Acquisition in a Prospective Nairobi-Based Female Sex Worker Cohort.
abstract: With two million new HIV infections annually, ongoing investigations of risk factors for HIV acquisition is critical to guide ongoing HIV prevention efforts. We conducted a prospective cohort analysis of HIV uninfected female sex workers enrolled at an HIV prevention clinic in Nairobi (n = 1640). In the initially HIV uninfected cohort (70 %), we observed 34 HIV infections during 1514 person-years of follow-up, i.e. an annual incidence of 2.2 % (95 % CI 1.6-3.1 %). In multivariable Cox Proportional Hazard analysis, HIV acquisition was associated with a shorter baseline duration of sex work (aHR 0.76, 95 % CI 0.63-0.91), minimum charge/sex act (aHR 2.74, 0.82-9.15, for low vs. intermediate; aHR 5.70, 1.96-16.59, for high vs. intermediate), N. gonorrhoeae infection (aAHR 5.89, 95 % CI 2.03-17.08), sex with casual clients during menses (aHR 6.19, 95 % CI 2.58-14.84), Depo Provera use (aHR 5.12, 95 % CI 1.98-13.22), and estimated number of annual unprotected regular partner contacts (aHR 1.004, 95 % CI 1.001-1.006). Risk profiling based on baseline predictors suggested that substantial heterogeneity in HIV risk is evident, even within a key population. These data highlight several risk factors for HIV acquisition that could help to re-focus HIV prevention messages.
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya. lyle.mckinnon@caprisa.org.|Department of Medicine, University of Toronto, Toronto, Canada. lyle.mckinnon@caprisa.org.|Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd floor DDMRI, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa. lyle.mckinnon@caprisa.org.
authors.forename: Lyle R
authors.initials: LR
authors.lastname: McKinnon
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Preston
authors.initials: P
authors.lastname: Izulla
authors.affiliation: Community Medicine, United Arab Emirates University, Al Ain, United Arab Emirates.|Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.
authors.forename: Nico
authors.initials: N
authors.lastname: Nagelkerke
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Julius
authors.initials: J
authors.lastname: Munyao
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Wanjiru
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Souradet Y
authors.initials: SY
authors.lastname: Shaw
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Richard
authors.initials: R
authors.lastname: Gichuki
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Kariuki
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Festus
authors.initials: F
authors.lastname: Muriuki
authors.affiliation: National AIDS & STI Control Programme (NASCOP), Ministry of Public Health and Sanitation, Nairobi, Kenya.
authors.forename: Helgar
authors.initials: H
authors.lastname: Musyoki
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Gloria
authors.initials: G
authors.lastname: Gakii
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.|Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Gelmon
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.|Department of Medicine, University of Toronto, Toronto, Canada.|Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Rupert
authors.initials: R
authors.lastname: Kaul
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.|Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kimani
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007630:Kenya; D011446:Prospective Studies; D012307:Risk Factors; D060386:Sex Workers; D055815:Young Adult
keywords: Co-factors of transmission; Female sex workers; HIV acquisition; HIV/AIDS; Prospective cohort; Risk profile