Abstract:
Introduction
HIV-1 prevention programs targeting HIV-1 serodiscordant couples need to identify couples
that are likely to become pregnant to facilitate discussions about methods to minimize HIV-
1 risk during pregnancy attempts (i.e. safer conception) or effective contraception when
pregnancy is unintended. A clinical prediction tool could be used to identify HIV-1 serodiscordant
couples with a high likelihood of pregnancy within one year.
Methods
Using standardized clinical prediction methods, we developed and validated a tool to identify
heterosexual East African HIV-1 serodiscordant couples with an increased likelihood
of becoming pregnant in the next year. Datasets were from three prospectively followed
cohorts, including nearly 7,000 couples from Kenya and Uganda participating in HIV-1 prevention
trials and delivery projects.
Results
The final score encompassed the age of the woman, woman’s number of children living,
partnership duration, having had condomless sex in the past month, and non-use of an
effective contraceptive. The area under the curve (AUC) for the probability of the score
to correctly predict pregnancy was 0.74 (95% CI 0.72–0.76). Scores 7 predicted a pregnancy incidence of >17% per year and captured 78% of the pregnancies. Internal and
external validation confirmed the predictive ability of the score.
