Background: 

HIV-1 risk scoring tools could help target provision of prevention modalities such as pre-exposure prophylaxis. Recent research suggests that risk scores for women aged 18–45 may not predict risk well among young women aged 18–24. We evaluated the predictive performance of age-specific risk scores compared with the existing non–age-specific VOICE risk score, developed for women aged 18–45.

Methods: 

We conducted a secondary analysis of the Evidence for Contraceptive Options and HIV Outcomes Trial to develop and internally validate HIV-1 risk scores for women aged 18–24 and 25–35 in South Africa. Candidate predictors included baseline demographic, clinical, behavioral, and contextual characteristics readily available in clinical settings. The VOICE risk score was applied to women aged 18–35. We evaluated predictive performance of each risk score by area under the receiver operating characteristic curve (AUC).

Results: 

Predictive performance of all risk scores was moderate, with AUC (95% confidence interval) of 0.64 (0.60 to 0.67) among women aged 18–24, 0.68 (0.62 to 0.73) among those aged 25–35, and 0.61 (0.58 to 0.65) for the VOICE risk score applied to women aged 18–35; The AUC was similar in internal validation. Among women aged 18–24, HIV-1 incidence was high even at low risk scores, at 3.9 per 100 person-years (95% confidence interval: 3.2 to 4.7).

Conclusions: 

All risk scores were moderately predictive of HIV-1 acquisition, and age-specific risk scores performed only marginally better than the VOICE non–age-specific risk score. Approaches for targeted pre-exposure prophylaxis provision to women in South Africa may require more extensive data than are currently available to improve prediction.

中文翻译：

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特定年龄的风险评分并不能改善南非女性的HIV-1预测

背景： 

HIV-1风险评分工具可以帮助提供预防手段，如暴露前预防。最近的研究表明对于风险分数女性18-45岁可能无法预测风险以及年轻人的女性年龄在18-24岁。与针对18-45岁女性制定的现有非年龄特定VOICE风险评分相比，我们评估了特定年龄风险评分的预测性能。

方法： 

我们对避孕方案和HIV结果试验的证据进行了二次分析，以开发和内部验证南非18-24岁和25-35岁女性的HIV-1风险评分。候选预测变量包括临床环境中容易获得的基线人口统计学，临床，行为和背景特征。VOICE风险评分适用于18-35岁的女性。我们按接收者操作特征曲线（AUC）下的面积评估了每个风险评分的预测性能。

结果： 

所有风险评分的预测表现均中等，18-24岁女性的AUC（95％置信区间）为0.64（0.60至0.67），25-35岁女性为0.68（0.62至0.73），以及0.61（0.58至0.65） ）适用于18-35岁女性的VOICE风险评分；AUC在内部验证中类似。在18-24岁的女性中，即使在低风险评分中，HIV-1的发生率仍然很高，每100人年3.9（95％的置信区间：3.2至4.7）。

结论： 

所有风险评分均能适度地预测HIV-1的获得，并且针对特定年龄段的风险评分仅略高于VOICE非针对年龄段的风险评分。途径有针对性的暴露前预防提供给妇女在南非可能需要更广泛的数据将比现有产品，以提高预测。