OA28.02
Background: Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) significantly reduce HIV transmission within heterosexual HIV serodiscordant couples. To maximize impact and minimize costs, ART and PrEP interventions should be offered to couples at highest risk of HIV transmission.
Methods: The Partners Demonstration Project is an open-label, prospective cohort study of PrEP and ART for HIV prevention among high risk HIV serodiscordant couples in Kenya and Uganda. We evaluated the feasibility of using a validated empiric risk score (Kahle et al. JAIDS 2013) that uses a combination of variables (age, number of children, male circumcision status, plasma HIV levels, condom use, marital status) to identify couples at highest risk for HIV transmission.
Results: Since November 2012, 1217 couples have screened and 714 enrolled. Of the screened couples, 274 (23%) scored 0–4 (anticipated HIV incidence of≤2% per year), 493 (41%) scored 5–6 (anticipated HIV incidence of ∼5% per year) and 450 (37%) scored≥7 (anticipated HIV incidence of≥7% per year). Couples scoring≥5 were eligible for enrollment and 76% entered the study. The median age of the HIV uninfected partner was 29.5 [IQR 26, 36] years and the HIV seronegative partner was male in 67% of partnerships. Over half (57%) had no children, 92% had unprotected sex in the month prior to screening and 34% of HIV susceptible men were uncircumcised. Among HIV infected members of the couples, the median CD4 count was 436 [IQR 274,634] cells/mm3 and 41.3% had a plasma viral load>50,000 copies/ml.
Conclusions: An empiric risk score derived from observational analyses of African HIV serodiscordant couples identified higher risk HIV discordant couples for a demonstration project of PrEP and ART for HIV prevention. Three-quarters of the higher risk couples who were eligible have enrolled. Risk scores could be useful for recruitment of higher risk persons and couples into future HIV prevention trials and demonstration projects.
