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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Lieb S, Fallon SJ, Friedman SR, Thompson, Gates GJ, Liberti TM, et al. Statewide estimation of racial/ethnic populations of men who have sex with men in the U.S. Public Health Rep. 2011;126(1):60–72.
Centers for Disease Control and Prevention. (2014) HIV Surveillance Report 26. http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2015. Accessed November 30, 2015.
Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS. 2007;21(15):2083–91.
Mimiaga MJ, Reisner SL, Cranston K, Isenberg D, Bright D, Daffin G, et al. Sexual mixing patterns and partner characteristics of black MSM in Massachusetts at increased risk for HIV infection and transmission. J Urban Health. 2009;86(4):602–23.
Maulsby C, Millett G, Lindsey K, Kelley R, Johnson K, Montoya D, et al. HIV among Black men who have sex with men (MSM) in the United States: a review of the literature. AIDS Behav. 2014;18(1):10–25.
Sullivan PS, Peterson J, Rosenberg ES, Kelley CF, Cooper H, Vaughan A, et al. Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. PLoS ONE. 2014;9(3):e90514.
Irvin R, Vallabhaneni S, Scott H, Williams JK, Wilton L, Li X, et al. Examining levels of risk behaviors among black men who have sex with Men (MSM) and the association with HIV acquisition. PLoS ONE. 2015;10(2):e0118281.
Sullivan PS, Rosenberg ES, Sanchez TH, Kelley CF, Luisi N, Cooper HL, et al. Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann Epidemiol. 2015;25(6):445–54.
Hess K, Hu X, Lanksy A, Mermin J, Hall HI. Estimating the lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2016;27(4):238–43.
Mackellar DA, Hou SI, Whalen CC, Samuelsen K, Sanchez T, Smith A, et al. Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV. Sex Transm Dis. 2011;38(5):419–28.
MacKellar DA, Valleroy LA, Secura GM, Behel S, Bingham T, Celentano DD, et al. Perceptions of lifetime risk and actual risk for acquiring HIV among young men who have sex with men. AIDS Behav. 2007;11(2):263–70.
Menza TW, Hughes JP, Celum CL, Golden MR. Prediction of HIV acquisition among men who have sex with men. Sex Transm Dis. 2009;36(9):547–55.
Smith DK, Pals SL, Herbst JH, Shinde S, Carey JW. Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2012;60(4):421–7.
Hoenigl M, Green N, Mehta SR, Little SJ. Risk factors for acute and early HIV infection among men who have sex with men (MSM) in San Diego, 2008 to 2014: a cohort study. Medicine. 2015;94(30):e1242.
Lancki N, Almirol E, Alon L, McNulty M, Schneider JA. Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago. AIDS. 2018;32(3):383–92.
Koblin B, Chesney M, Coates T, Team ES. Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomised controlled study. Lancet. 2004;364(9428):41–50.
Bartholow BN, Goli V, Ackers M, McLellan E, Gurwith M, Durham M, et al. Demographic and behavioral contextual risk groups among men who have sex with men participating in a phase 3 HIV vaccine efficacy trial: implications for HIV prevention and behavioral/biomedical intervention trials. J Acquir Immune Defic Syndr. 2006;43(5):594–602.
Hammer SM, Sobieszczyk ME, Janes H, Karuna ST, Mulligan MJ, Grove D, et al. Efficacy trial of a DNA/rAd5 HIV-1 preventive vaccine. N Engl J Med. 2013;369(22):2083–92.
Koblin B, Mayer K, Eshleman S, Wang L, Mannheimer S, et al. Correlates of HIV acquisition in a cohort of black men who have sex with men in the United States: HIV prevention trials network (HPTN). PLoS ONE. 2013;8(7):e70413.
Mayer KH, Wang L, Koblin B, Mannheimer S, Magnus M, Del Rio C, et al. Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among Black men who have sex with men in 6 U.S. cities. PLoS ONE. 2014;9(1):e87298.
Rothman AJ. Toward a theory-based analysis of behavioral maintenance. Health Psychol. 2000;19(1 Suppl):64–9.
Gallagher KM, Updegraff JA. Health message framing effects on attitudes, intentions, and behavior: a meta-analytic review. Ann Behav Med. 2012;43(1):101–16.
Buchbinder SP, Vittinghoff E, Heagerty PJ, Celum CL, Seage GR, Judson FN, et al. Sexual risk, nitrite inhalant use, and lack of circumcision associated with HIV seroconversion in men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2005;39(1):82–9.
Woody GE, Donnell D, Seage GR, Metzger D, Marmor M, Koblin BA, et al. Non-injection substance use correlates with risky sex among men having sex with men: data from HIVNET. Drug Alcohol Depend. 1999;53(3):197–205.
Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20(5):731–9.
Scott HM, Vittinghoff E, Irvin R, Sachdev D, Liu A, Gurwith M, et al. Age, race/ethnicity, and behavioral risk factors associated with per contact risk of HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2014;65(1):115–21.
CDC. (2014) Pre-exposure prophylaxis for prevention of HIV infection in the United States—2014: a clinical practice guideline. May 2014. Available at: http://www.cdc.gov/hiv/guidelines/preventing.html.
Wejnert C, Hess KL, Rose CE, Balaji A, Smith JC, Paz-Bailey G, et al. Age-specific race and ethnicity disparities in HIV infection and awareness among men who have sex with men-20 US Cities, 2008–2014. J Infect Dis. 2015;213(5):776–83.
Baral S, Logie CH, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13:482.
Poundstone KE, Strathdee SA, Celentano DD. The social epidemiology of human immunodeficiency virus/acquired immunodeficiency syndrome. Epidemiol Rev. 2004;26:22–35.
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019;393(10189):2428–38.
Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive Antiretroviral therapy. JAMA. 2016;316(2):171–81.
US CDC News. Dear colleague: national gay men’s HIV/AIDS awareness day. (27 September 2017). https://www.cdc.gov/hiv/library/dcl/dcl/092717.html. 2017.
ClinicalTrials.gov. Safety and Efficacy Study of Injectable Cabotegravir Compared to Daily Oral Tenofovir Disoproxil Fumarate/Emtricitabine (TDF/FTC), For Pre-Exposure Prophylaxis in HIV-Uninfected Cisgender Men and Transgender Women Who Have Sex With Men. Bethesda, MD: National Library of Medicine. Identifier: NCT02720094. Available from: https://clinicaltrials.gov/ct2/show/NCT02720094.
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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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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DOI: https://doi.org/10.1007/s10461-019-02616-3