title: A Risk Assessment Tool for Identifying Pregnant and Postpartum Women Who May Benefit From Preexposure Prophylaxis.
abstract: A human immunodeficiency virus (HIV) risk assessment tool for pregnant women could identify women who would most benefit from preexposure prophylaxis (PrEP) while minimizing unnecessary PrEP exposure.
  
  
  
  Data from a prospective study of incident HIV among pregnant/postpartum women in Kenya were randomly divided into derivation (n = 654) and validation (n = 650) cohorts. A risk score was derived using multivariate Cox proportional hazards models and standard clinical prediction rules. Ability of the tool to predict maternal HIV acquisition was assessed using the area under the curve (AUC) and Brier score.
  
  
  
  The final risk score included the following predictors: having a male partner with unknown HIV status, number of lifetime sexual partners, syphilis, bacterial vaginosis (BV), and vaginal candidiasis. In the derivation cohort, AUC was 0.84 (95% confidence interval [CI], .72-.95) and each point increment in score was associated with a 52% (hazard ratio [HR], 1.52 [95% CI, 1.32-1.76]; P < .001) increase in HIV risk; the Brier score was 0.11. In the validation cohort, the score had similar AUC, Brier score, and estimated HRs. A simplified score that excluded BV and candidiasis yielded an AUC of 0.76 (95% CI, .67-.85); HIV incidence was higher among women with risk scores >6 than with scores ≤6 (7.3 vs 1.1 per 100 person-years, respectively; P < .001). Women with simplified scores >6 accounted for 16% of the population but 56% of HIV acquisitions.
  
  
  
  A combination of indicators routinely assessed in antenatal clinics was predictive of HIV risk and could be used to prioritize pregnant women for PrEP.
authors.affiliation: Department of Global Health, University of Washington, Seattle, USA.|Family and Child Nursing, University of Washington, Seattle, USA.
authors.forename: Jillian
authors.initials: J
authors.lastname: Pintye
authors.affiliation: Department of Global Health, University of Washington, Seattle, USA.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Drake
authors.affiliation: Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Kinuthia
authors.affiliation: Departments of Global Health and Obstetrics and Gynecology, University of Washington, Box 359909, Seattle, WA, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Unger
authors.affiliation: Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
authors.forename: Daniel
authors.initials: D
authors.lastname: Matemo
authors.affiliation: Department of Global Health, University of Washington, Seattle, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Renee A
authors.initials: RA
authors.lastname: Heffron
authors.affiliation: Department of Global Health, University of Washington, Seattle, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.|Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Ruanne V
authors.initials: RV
authors.lastname: Barnabas
authors.affiliation: Department of Global Health, University of Washington, Seattle, USA.|Psychosocial and Community Health, University of Washington, Seattle, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kohler
authors.affiliation: Department of Global Health, University of Washington, Seattle, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.|Department of Medicine, University of Washington, Seattle, Washington, USA.|University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya.
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.affiliation: Department of Global Health, University of Washington, Seattle, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.|Department of Medicine, University of Washington, Seattle, Washington, USA.|Department of Pediatrics, University of Washington, Seattle, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
mesh_terms: D000328:Adult; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D049590:Postpartum Period; D065129:Pre-Exposure Prophylaxis / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D055815:Young Adult
keywords: HIV; PrEP; postpartum.; preexposure prophylaxis; pregnancy; risk score