title: A Scoring Tool to Identify East African HIV-1 Serodiscordant Partnerships with a High Likelihood of Pregnancy.
abstract: BACKGROUND
  HIV-1 prevention programs targeting HIV-1 serodiscordant couples need to identify couples that are likely to become pregnant to facilitate discussions about methods to minimize HIV-1 risk during pregnancy attempts (i.e. safer conception) or effective contraception when pregnancy is unintended. A clinical prediction tool could be used to identify HIV-1 serodiscordant couples with a high likelihood of pregnancy within one year.
  
  
  METHODS
  Using standardized clinical prediction methods, we developed and validated a tool to identify heterosexual East African HIV-1 serodiscordant couples with an increased likelihood of becoming pregnant in the next year. Datasets were from three prospectively followed cohorts, including nearly 7,000 couples from Kenya and Uganda participating in HIV-1 prevention trials and delivery projects.
  
  
  RESULTS
  The final score encompassed the age of the woman, woman's number of children living, partnership duration, having had condomless sex in the past month, and non-use of an effective contraceptive. The area under the curve (AUC) for the probability of the score to correctly predict pregnancy was 0.74 (95% CI 0.72-0.76). Scores ≥ 7 predicted a pregnancy incidence of >17% per year and captured 78% of the pregnancies. Internal and external validation confirmed the predictive ability of the score.
  
  
  CONCLUSIONS
  A pregnancy likelihood score encompassing basic demographic, clinical and behavioral factors defined African HIV-1 serodiscordant couples with high one-year pregnancy incidence rates. This tool could be used to engage African HIV-1 serodiscordant couples in counseling discussions about fertility intentions in order to offer services for safer conception or contraception that align with their reproductive goals.
authors.affiliation: Department of Global Health, University of Washington, Seattle, United States of America.|Department of Epidemiology, University of Washington, Seattle, United States of America.
authors.forename: Renee
authors.initials: R
authors.lastname: Heffron
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, United States of America.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.affiliation: Department of Global Health, University of Washington, Seattle, United States of America.|Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ngure
authors.affiliation: Department of Global Health, University of Washington, Seattle, United States of America.|Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bukusi
authors.affiliation: Department of Reproductive Health, Moi University, Eldoret, Kenya.
authors.forename: Edwin
authors.initials: E
authors.lastname: Were
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: James
authors.initials: J
authors.lastname: Kiarie
authors.affiliation: Department of Global Health, University of Washington, Seattle, United States of America.|Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.|Department of Obstetrics & Gynecology, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
authors.affiliation: Department of Global Health, University of Washington, Seattle, United States of America.|Department of Epidemiology, University of Washington, Seattle, United States of America.|Department of Medicine, University of Washington, Seattle, United States of America.
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.affiliation: Department of Global Health, University of Washington, Seattle, United States of America.|Department of Epidemiology, University of Washington, Seattle, United States of America.|Department of Medicine, University of Washington, Seattle, United States of America.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D044383:Black People; D003267:Contraception / Q000379:methods; D003270:Contraceptive Agents / Q000008:administration & dosage; D003273:Contraceptive Devices; D003376:Counseling / Q000379:methods; D005191:Family Characteristics; D005260:Female; D005298:Fertility / Q000187:drug effects; D005306:Fertilization / Q000187:drug effects; D018023:HIV Seronegativity / Q000502:physiology; D006679:HIV Seropositivity / Q000635:transmission*; D015497:HIV-1 / Q000187:drug effects / Q000472:pathogenicity; D020010:Heterosexuality / Q000502:physiology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control* / Q000821:virology*; D011446:Prospective Studies; D012747:Sexual Partners; D014454:Uganda
chemical_list: D003270:Contraceptive Agents