title: Use of a risk scoring tool to identify higher-risk HIV-1 serodiscordant couples for an antiretroviral-based HIV-1 prevention intervention.
abstract: BACKGROUND
  Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) reduce HIV-1 transmission within heterosexual HIV-1 serodiscordant couples. Prioritizing couples at highest HIV-1 transmission risk for ART and PrEP would maximize impact and minimize costs.
  
  
  METHODS
  The Partners Demonstration Project is an open-label, delivery study of integrated PrEP and ART for HIV-1 prevention among high risk HIV-1 serodiscordant couples in Kenya and Uganda. We evaluated the feasibility of using a validated risk score that weighs a combination of easily measurable factors (age, children, marital status, male circumcision status, condom use, plasma HIV-1 levels) to identify couples at highest risk for HIV-1 transmission for enrollment. Couples scoring ≥5 met the risk score eligibility criteria.
  
  
  RESULTS
  We screened 1694 HIV-1 serodiscordant couples and enrolled 1013. Of the screened couples, 1331 (78.6 %) scored ≥5 (with an expected incidence >3 % per year) and 76 % of these entered the study. The median age of the HIV-1 uninfected partner was 29 years [IQR 26, 36] and 20 % were <25 years of age. The HIV-1 uninfected partner was male in 67 % of partnerships, 33 % of whom were uncircumcised, 57 % of couples had no children, and 65 % reported unprotected sex in the month prior to enrollment. Among HIV-1 infected partners, 41 % had plasma viral load >50,000 copies/ml.
  
  
  CONCLUSIONS
  A risk scoring tool identified HIV-1 serodiscordant couples for a demonstration project of PrEP and ART with high HIV-1 risk. The tool may be feasible for research and public health settings to maximize efficiency and minimize HIV-1 prevention costs.
authors.affiliation: College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000-00200, Nairobi, Kenya. eirungu@pipsthika.org.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Irungu
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.|Department of Epidemiology, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Heffron
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.|Centre for Clinical Research, Kenya Medical Research Institute, Mbagathi Road, Nairobi, Kenya.
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
authors.affiliation: College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, P. O. Box 62000-00200, Nairobi, Kenya.|Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ngure
authors.affiliation: Department of Medicine, Makerere University, PO Box 7072, Kampala, Uganda.|Infectious Disease Institute, College of Health Sciences, Makerere University , Kampala, Uganda.
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.affiliation: Infectious Disease Institute, College of Health Sciences, Makerere University , Kampala, Uganda.
authors.forename: Nulu
authors.initials: N
authors.lastname: Bulya
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.|Department of Obstetrics & Gynaecology, University of Nairobi, Uhuru Highway, Nairobi, 00100, Kenya.|Center for Microbiology Research, Kenya Medical Research Institute, Mbagathi Road, Nairobi, Kenya.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bukusi
authors.affiliation: Center for Microbiology Research, Kenya Medical Research Institute, Mbagathi Road, Nairobi, Kenya.
authors.forename: Josephine
authors.initials: J
authors.lastname: Odoyo
authors.affiliation: Kabwohe Clinical Research Centre, Off Kabwohe-Ishaka HWY next to ICOBI, Kabwohe-Itendero Town Council, Box 347, Bushenyi District Kabwohe, Uganda.
authors.forename: Stephen
authors.initials: S
authors.lastname: Asiimwe
authors.affiliation: Kabwohe Clinical Research Centre, Off Kabwohe-Ishaka HWY next to ICOBI, Kabwohe-Itendero Town Council, Box 347, Bushenyi District Kabwohe, Uganda.
authors.forename: Edna
authors.initials: E
authors.lastname: Tindimwebwa
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.|Department of Epidemiology, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.|Department of Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.affiliation: Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.|Department of Epidemiology, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.|Department of Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002944:Circumcision, Male; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1 / Q000472:pathogenicity*; D020010:Heterosexuality; D006801:Humans; D007630:Kenya; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012747:Sexual Partners; D014454:Uganda; D047568:Unsafe Sex; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Africa; Delivery; HIV; PrEP; Screening tool; Serodiscordant couples