An Approach to Developing a Prediction Model of Fertility Intent Among HIV-Positive Women and Men in Cape Town, South Africa: A Case Study.
As a 'case-study' to demonstrate an approach to establishing a fertility-intent prediction model, we used data collected from recently diagnosed HIV-positive women (N = 69) and men (N = 55) who reported inconsistent condom use and were enrolled in a sexual and reproductive health intervention in public sector HIV care clinics in Cape Town, South Africa. Three theoretically-driven prediction models showed reasonable sensitivity (0.70-1.00), specificity (0.66-0.94), and area under the receiver operating characteristic curve (0.79-0.89) for predicting fertility intent at the 6-month visit. A k-fold cross-validation approach was employed to reduce bias due to over-fitting of data in estimating sensitivity, specificity, and area under the curve. We discuss how the methods presented might be used in future studies to develop a clinical screening tool to identify HIV-positive individuals likely to have future fertility intent and who could therefore benefit from sexual and reproductive health counseling around fertility options.
Department of Biostatistics, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA.|Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Dan
D
Bai
Department of Biostatistics, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA.|HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA.
Cheng-Shiun
CS
Leu
HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA. jem57@cumc.columbia.edu.
Joanne E
JE
Mantell
HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA.
Theresa M
TM
Exner
Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa.|University of Western Cape School of Public Health, Cape Town, South Africa.
Diane
D
Cooper
HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA.|Department of Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA.
Susie
S
Hoffman
HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA.|Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
Elizabeth A
EA
Kelvin
Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa.
Landon
L
Myer
Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa.
Debbie
D
Constant
Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa.|Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Jennifer
J
Moodley
D000328:Adult; D019540:Area Under Curve; D003661:Decision Support Techniques; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D033182:Intention; D008297:Male; D012372:ROC Curve; D043762:Reproductive Behavior; D012106:Research; D012725:Sexual Behavior; D013019:South Africa
Area under the curve (AUC) of the ROC; Childbearing; HIV infection; HIV-positive women and men; Receiving operating characteristic (ROC) curve; Reproductive intentions; Sensitivity; South Africa; Specificity; k-fold cross-validation