Diagnostic performance of HIV risk assessment tools for identifying pre-exposure prophylaxis candidates: a systematic review and meta-analysis.

IF 10 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
EClinicalMedicine Pub Date : 2025-09-17 eCollection Date: 2025-10-01 DOI:10.1016/j.eclinm.2025.103487
Myo Minn Oo, Monica Rudd, Caley Shukalek, Teruko Kishibe, Mark Hull, Darrell H S Tan
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引用次数: 0

Abstract

Background: To support the implementation of HIV pre-exposure prophylaxis (PrEP), we conducted a systematic review and meta-analysis evaluating the diagnostic performance of HIV risk assessment tools in predicting HIV infection.

Methods: We searched MEDLINE, Embase, and CINAHL for observational studies published between January 1, 1998, and May 13, 2024 that reported on the diagnostic performance of HIV risk assessment tools. We calculated pooled area under the curve (pAUC) values using inverse variance methods, with sensitivity and specificity reported at common cutoffs (PROSPERO registration number: CRD42024543975).

Findings: Of 3704 publications, 27 met our criteria. Twelve studies on men who have sex with men (MSM) assessed nine tools, with four extensively validated, predominantly in U.S. populations. SexPro exhibited the highest performance (pAUC: 0.75), while HIRI-MSM (pAUC: 0.69), Menza (pAUC: 0.63), and SDET (pAUC: 0.66) demonstrated moderate predictive ability, with considerable heterogeneity. For cisgender women, twelve African studies evaluated six tools, with VOICE being the only extensively validated tool (pAUC: 0.65 for adult females; 0.62 for adolescent and young women). Although additional tools were available for subgroups within Africa, there were no tools for cisgender women outside Africa. Among other populations, DHRS demonstrated good discrimination for general U.S. adults (pAUC: 0.80), as did the HIV Prevalence Risk Score for African mixed populations (AUC: 0.70), Kahle for heterosexual serodiscordant couples in Africa (pAUC: 0.73), and ARCH-IDU for people who use drugs in the U.S. (pAUC: 0.72). Sensitivity and specificity varied by cutoffs. Tool items fell into six domains: sexual activities, substance use, clinical factors, demographics, reproductive health, and other factors, with complexity differing by population and context.

Interpretation: Validated tools can help identify HIV risk in some populations, but tools are still needed to promote equitable PrEP access for subpopulations such as cisgender women outside Africa. Public health programs and clinicians should consider incorporating up-to-date, local data to enhance the relevance and effectiveness of existing tools.

Funding: This work was supported by the Canadian Institutes of Health Research (Grant number PCS - 183410). DHST is supported by a Tier 2 Canada Research Chair in Biomedical HIV/STI Prevention.

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用于确定暴露前预防候选人的HIV风险评估工具的诊断性能:系统回顾和荟萃分析。
背景:为了支持HIV暴露前预防(PrEP)的实施,我们对HIV风险评估工具在预测HIV感染方面的诊断性能进行了系统回顾和荟萃分析。方法:我们检索MEDLINE、Embase和CINAHL,检索1998年1月1日至2024年5月13日期间发表的关于HIV风险评估工具诊断性能的观察性研究。我们使用反方差方法计算曲线下的汇总面积(pAUC)值,在共同截止点报告敏感性和特异性(PROSPERO注册号:CRD42024543975)。结果:在3704篇出版物中,27篇符合我们的标准。12项针对男男性行为者(MSM)的研究评估了9种工具,其中4种被广泛验证,主要在美国人群中进行。SexPro表现出最高的预测能力(paulc: 0.75),而iri - msm (paulc: 0.69)、Menza (paulc: 0.63)和SDET (paulc: 0.66)表现出中等的预测能力,具有相当大的异质性。对于顺性别女性,12项非洲研究评估了6种工具,VOICE是唯一得到广泛验证的工具(成年女性的pac: 0.65;青少年和年轻女性的pac: 0.62)。虽然非洲境内的小群体有其他工具,但非洲以外没有针对顺性别妇女的工具。在其他人群中,DHRS对普通美国成年人(pAUC: 0.80)、非洲混合人群的HIV流行风险评分(AUC: 0.70)、非洲异性恋血清不一致夫妇的Kahle (pAUC: 0.73)和美国吸毒者的ARCH-IDU (pAUC: 0.72)也表现出良好的歧视。敏感性和特异性因截止值而异。工具项目分为六个领域:性活动、物质使用、临床因素、人口统计、生殖健康和其他因素,其复杂性因人口和环境而异。解释:经过验证的工具可以帮助识别某些人群中的艾滋病毒风险,但仍然需要工具来促进非洲以外的亚人群(如顺性别妇女)公平获得PrEP。公共卫生规划和临床医生应考虑纳入最新的当地数据,以提高现有工具的相关性和有效性。资助:本研究由加拿大卫生研究院支持(授权号PCS - 183410)。DHST由加拿大生物医学艾滋病毒/性传播感染预防二级研究主席提供支持。
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来源期刊
EClinicalMedicine
EClinicalMedicine Medicine-Medicine (all)
CiteScore
18.90
自引率
1.30%
发文量
506
审稿时长
22 days
期刊介绍: eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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