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.
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Acknowledgments
We would like to thank all of the staff at the SWOP City clinic and Kenya AIDS Control Project, University of Nairobi/Manitoba for their support. Funding was provided by US-PEPFAR (CDC-PEPFAR U62/CCU024510-01) to L.G. and J.K. and CIHR MOP-89983 to R.K. R.K. is supported by an OHTN Career Scientist Award. L.R.M. was supported by a CIHR fellowship and the International Infectious Diseases and Global Health Training Program.
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Lyle R. McKinnon and Preston Izulla are Co-first authors.
Rupert Kaul and Joshua Kimani1 are Co-last authors.
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McKinnon, L.R., Izulla, P., Nagelkerke, N. et al. Risk Factors for HIV Acquisition in a Prospective Nairobi-Based Female Sex Worker Cohort. AIDS Behav 19, 2204–2213 (2015). https://doi.org/10.1007/s10461-015-1118-7
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DOI: https://doi.org/10.1007/s10461-015-1118-7