Development and Validation of the Personalized Sexual Health Promotion (SexPro) HIV Risk Prediction Model for Men Who Have Sex with Men in the United States

Abstract

Accurate HIV risk assessment among men who have sex with men (MSM) is important to help providers assess risk, and target HIV prevention interventions. We sought to develop an evidence-based HIV risk assessment tool for US MSM that is inclusive of Black MSM. Data from four large longitudinal cohorts of MSM were used to develop (EXPLORE), and validate (VAX004, HPTN061, and HVTN505). These data included visits in which participants self-reported HIV risk behavior and underwent HIV testing. We developed a pooled logistic model for incident HIV infection based on self-reported risk behaviors during the 6 months before each study visit. A total of 4069 MSM were used for the development cohort, and 8047 MSM in the three validation cohorts through 2013. The final model includes age (< 35, ≥ 35); Black race and Latino ethnicity; numbers of HIV-negative anal sex partners; number of insertive or receptive anal intercourse episodes; having 1 HIV-negative partner only; self-reported substance use; and bacterial sexually transmitted infection diagnosis. The model showed good discrimination in internal validation (C-statistic = 79.5). The external validation cohorts also showed good discrimination, with C-statistics of 73.1, 71.0, 71.9 in VAX004, HPTN061, and HVTN505 respectively, and acceptable calibration. We developed and validated an HIV risk assessment tool for MSM, which showed good predictive ability, including among the largest cohort of HIV-uninfected Black MSM in the US. This tool is available online (mysexpro.org) and can be used by providers to support targeting of HIV prevention interventions such as pre-exposure prophylaxis for MSM.

Keywords: HIV prevention; HIV risk assessment; MSM.

Figure 1:

Predicted and Observed HIV Infection Risk in EXPLORE, VAX004, HIV Prevention Trials Network 061, and HIV Vaccine Trials Network 505 Cohort Studies.* * C-statistics for internal validation in the development cohort EXPLORE=79.5; and external validation cohorts VAX004=73.1, HPTN 061=71.0, and HVTN 505=71.9. The Sex Pro Score risk strata of 16–20 for HPTN 061 is blank because all participants in this cohort had predicted and observed Sex Pro scores of <16.

Figure 2:

Area under Receiver Operator Curve (AUC) for Explore, VAX004, HIV Prevention Trials Network 061, and HIV Vaccine Trials Network 505 Cohort Studies.* * AUC for internal validation in the development cohort EXPLORE=0.80; and external validation cohorts VAX004=0.73, HPTN 061=0.71, and HVTN 505=0.72.