Fidler, S

Fox, J

Jones, C

Kuldanek, K

Platt, L

Smith, A

Vickerman, P

English

LSHTM Research Online

Jones, C; Kuldanek, K; Vickerman, P; Smith, A; Fox, J; Platt, L;Fidler, S (2013) Evaluation of an HIV risk score within an outpatientsexual health clinic. In: UNSPECIFIED.Downloaded from: http://researchonline.lshtm.ac.uk/856555/Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna-tively contact researchonline@lshtm.ac.uk.Available under license: Creative Commons Attribution Non-commercialhttp://creativecommons.org/licenses/by-nc/2.5/Evaluation of a HIV risk score within an outpatient sexual health clinic. CB Jones,1 I. K Kuldanek,1 P Vickerman,2  A Smith,3 J Fox,4 L Platt,2 and S Fidler,1   1Imperial College London, 2London School of Hygiene and tropical medicine, 3Imperial College Healthcare NHS trust and  4Guys and St Thomas’ hospital, London           BACKGROUND A risk score model incorporating sexual behaviour, circumcision status, viral load and genital ulcer disease has been described for the evaluation of risk of HIV transmission within sero-discordant couple cohorts1. The aim of this study was to assess the feasibility of extending the model for use amongst a cross section of  individuals attending a sexual health clinic for HIV testing, and to assess the relationship between calculated scores and HIV status at attendance.  Conclusions Calculation of HIV risk scores is feasible using a self-completed questionnaire within a sexual health clinic at a single patient visit. Although the numbers of HIV positive individuals within this sample were small calculated scores showed utility in the estimation of risk of HIV infection.  METHODS Between October 2010 and May 2011 individuals requesting HIV testing at a London sexual health service were prospectively recruited to a validation study of a HIV point of care test (POCT). As a sub-study participants self-completed a paper based questionnaire prior to HIV test results examining their sexual behaviour during the three months prior. Responses were linked to HIV and STI results.   A modified algorithm1 was developed incorporating  the risk per sexual act (defined by BHIVA PEP guidelines) local HIV prevalence, partner viral load, active genital ulcer disease, history of herpes (surrogate for herpes serology) and  circumcision status as multiplyers.  Calculating risk for a single act   Ra= βtype x ΑVL x γGUD x πHSV-2 x Ψcirc x ρprevalence  Βtype – refers to the risk per type of sex act (BHIVA PEP guidelines2)   Calculating cumulative risk  over  3 months   RRisk Score  = 1 – ( (1 – RPartner1) x (1 – RPartner2) X (1 – RtPartner3) etc)  Cumulative risk scores over the three months were calculated in Microsoft Excel and categorised as per the thresholds defined in the BHIVA post exposure prophylaxis guidelines2, see Figure 1 (low risk score <1/10,000; medium risk 1/10,000 – 1/1000;  high risk 1/1,000-1/200; very high risk >1/200). Exact logistic regression was performed in STATA 12 to assess associations between calculated risk score and HIV status. TABLE 1  RESULTS 625/985 (63.5%) participants within the POCT study sufficiently completed the questionnaire to allow calculation of a risk score of whom 554 (88.6%) were men (see table 1 for demographics). The median age of participants was 30.5 years old and 84.5% were identified as MSM. 12/625 (1.9%) screened HIV positive at participation.  Calculated cumulative risk scores ranged from zero (where the participant reported no unprotected sex) to a maximum of just over 1/5 (21%) of testing HIV positive, see Figure 2. Participants with scores in the ‘high risk’ group (>1/1000 & <1/200) had increased odds of being diagnosed HIV positive at study participation compared to those with scores in the ‘low risk’ group (odds ratio = 5.47, p = 0.04). Those with calculated scores in the ‘very high risk’ range (>1/200) had even greater odds of HIV diagnosis at participation (odds ratio = 12.81, p=0.04) see Figure 3.   FIGURE 3 - % Participants testing HIV positive by risk score Demographics   Frequency (column %) Sex    Female  71 (11.4) Male  554 (88.6) Total  625  Risk factor Heterosexual  89 (14.2) IDU  2 (0.3) MSM  528 (84.5) Not Known  6 (1.0) Total  625 Born in the UK No  325 (53.0) Yes  288 (47.0) Total  613 Median (IQR) Age at participation (years)  30.5 (26.4-38.8) FIGURE 2 – Distribution of risk scores in those with score >0 (n=370)  FIGURE 1 REFERENCES  1. Fox et al: AIDS 2011 May 15;25(8):1065-82          2. Benn et al: Int J STD AIDS. 2011 Dec;22(12):695-708     

Evaluation of an HIV risk score within an outpatient sexual health clinic

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Evaluation of an HIV risk score within an outpatient sexual health clinic

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