An Empiric Risk Score to Guide PrEP Targeting Among MSM in Coastal Kenya

AIDS Behav. 2018 Jul;22(Suppl 1):35-44. doi: 10.1007/s10461-018-2141-2.


Men who have sex with men (MSM), who have heterogeneous HIV-acquisition risks are not specifically targeted in Kenyan pre-exposure prophylaxis (PrEP) guidelines. We used data from an open cohort, which followed 753 initially HIV-negative MSM participants for more than 1378.5 person-years, to develop an empiric risk score for targeting PrEP delivery. Independent predictors of incident HIV-1 infection in this cohort were an age of 18-24 years, having only male sex partners, having receptive anal intercourse, having any unprotected sex, and having group sex. Poisson model coefficients were used to assign a numeric score to each statistically significant predictor. A risk score of ≥ 1 corresponded to an HIV-1 incidence of ≥ 2.2 [95% confidence interval (CI) 1.2-4.1] and identified 81.3% of the cohort participants as being at high risk for HIV-1 acquisition. The area under the receiver operating characteristic curve was 0.76 (95% CI 0.71-0.80). This empiric risk score may help Kenyan health care providers to assess HIV-1 acquisition risk and encourage PrEP uptake by high-risk MSM.

Keywords: HIV-1 acquisition; Kenya; MSM; PrEP; Risk score.

MeSH terms

  • Adolescent
  • Cohort Studies
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • HIV Seropositivity
  • HIV-1
  • Homosexuality, Male*
  • Humans
  • Incidence
  • Kenya
  • Male
  • Pre-Exposure Prophylaxis*
  • Risk Assessment / methods*
  • Risk-Taking*
  • Sexual Behavior
  • Sexual Partners
  • Sexual and Gender Minorities
  • Unsafe Sex
  • Young Adult