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Development and Validation of the Personalized Sexual Health Promotion (SexPro) HIV Risk Prediction Model for Men Who Have Sex with Men in the United States

Abstract

Accurate HIV risk assessment among men who have sex with men (MSM) is important to help providers assess risk, and target HIV prevention interventions. We sought to develop an evidence-based HIV risk assessment tool for US MSM that is inclusive of Black MSM. Data from four large longitudinal cohorts of MSM were used to develop (EXPLORE), and validate (VAX004, HPTN061, and HVTN505). These data included visits in which participants self-reported HIV risk behavior and underwent HIV testing. We developed a pooled logistic model for incident HIV infection based on self-reported risk behaviors during the 6 months before each study visit. A total of 4069 MSM were used for the development cohort, and 8047 MSM in the three validation cohorts through 2013. The final model includes age (< 35, ≥ 35); Black race and Latino ethnicity; numbers of HIV-negative anal sex partners; number of insertive or receptive anal intercourse episodes; having 1 HIV-negative partner only; self-reported substance use; and bacterial sexually transmitted infection diagnosis. The model showed good discrimination in internal validation (C-statistic = 79.5). The external validation cohorts also showed good discrimination, with C-statistics of 73.1, 71.0, 71.9 in VAX004, HPTN061, and HVTN505 respectively, and acceptable calibration. We developed and validated an HIV risk assessment tool for MSM, which showed good predictive ability, including among the largest cohort of HIV-uninfected Black MSM in the US. This tool is available online (mysexpro.org) and can be used by providers to support targeting of HIV prevention interventions such as pre-exposure prophylaxis for MSM.

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Acknowledgement

The HIV Prevention Trials Network (HPTN) is funded by the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Child Health and Human Development (NICH/HD), National Institute of Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH), Office of AIDS Research, National Institutes of Health (NIH), Department of Health and Human Services. This work was also supported by the National Institutes of Health [K23MH104116 to H.M.S]. The authors would like to thank the study participants; and HPTN 061 Protocol Co-Chairs: Beryl Koblin, PhD, Kenneth Mayer, MD, and Darrell Wheeler, PhD, MPH; Emory University (Ponce de Leon Center & Hope Clinic Clinical Research Sites): Carlos del Rio, Paula Frew, Christin Root, Jermel L. Wallace; Fenway Institute at Fenway Health: Kenneth Mayer, Benjamin Perkins, Kelvin Powell, Benny Vega; George Washington University School of Public Health and Health Services: Manya Magnus, Alan Greenberg, Jeanne Jordan, Irene Kuo, Gregory Phillips II, Christopher Watson; Harlem Prevention Center: Sharon Mannheimer, Avelino Loquere Jr.; New York Blood Center: Beryl Koblin, Krista Goodman, Hong Van Tieu; San Francisco Department of Public Health: Susan P. Buchbinder, Michael Arnold, Chadwick Campbell, Mathew Sanchez; University of California Los Angeles (UCLA): Steven J. Shoptaw, Christopher Hucks-Ortiz; HPTN Coordinating and Operations Center (CORE), FHI 360; Sam Griffith, Erica Hamilton, LaShawn Jones, Georgette King, Jonathan Paul Lucas, Teresa Nelson; HPTN Network Laboratory, Johns Hopkins Medical Institute: Sue Eshleman, Vanessa Cummings; HPTN Statistical and Data Management Center, Statistical Center for HIV/AIDS Research and Prevention (SCHARP): Lei Wang, Corey Kelly, Ting-Yuan Liu; Division of AIDS (DAIDS) at the U.S. National Institutes of Health (NIH): Jane Bupp, Vanessa Elharrar; Additional HPTN 061 Protocol Team Members: Darrell Wheeler (co-chair), Sheldon Fields, Kaijson Noilmar, Steven Wakefield; Other HPTN 061 Contributors: Black Gay Research Group, HPTN Black Caucus, Kate MacQueen, Leo Wilton. We thank the HVTN 505 study participants and protocol team, the NIH National Institute of Allergy and Infectious Diseases (NIAID), and the NIAID-funded HIV Vaccine Trials Network for providing the clinical trial data from HVTN 505.

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Correspondence to Hyman Scott.

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Scott, H., Vittinghoff, E., Irvin, R. et al. Development and Validation of the Personalized Sexual Health Promotion (SexPro) HIV Risk Prediction Model for Men Who Have Sex with Men in the United States. AIDS Behav 24, 274–283 (2020). https://doi.org/10.1007/s10461-019-02616-3

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Keywords

  • HIV risk assessment
  • MSM
  • HIV prevention