Abstract:
Background: Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) reduce HIV-1 transmission within
heterosexual HIV-1 serodiscordant couples. Prioritizing couples at highest HIV-1 transmission risk for ART and PrEP
would maximize impact and minimize costs.
Methods: The Partners Demonstration Project is an open-label, delivery study of integrated PrEP and ART for HIV-1
prevention among high risk HIV-1 serodiscordant couples in Kenya and Uganda. We evaluated the feasibility of
using a validated risk score that weighs a combination of easily measurable factors (age, children, marital status,
male circumcision status, condom use, plasma HIV-1 levels) to identify couples at highest risk for HIV-1 transmission
for enrollment. Couples scoring ≥5 met the risk score eligibility criteria.
Results: We screened 1694 HIV-1 serodiscordant couples and enrolled 1013. Of the screened couples, 1331 (78.6 %)
scored ≥5 (with an expected incidence >3 % per year) and 76 % of these entered the study. The median age of
the HIV-1 uninfected partner was 29 years [IQR 26, 36] and 20 % were <25 years of age. The HIV-1 uninfected
partner was male in 67 % of partnerships, 33 % of whom were uncircumcised, 57 % of couples had no children,
and 65 % reported unprotected sex in the month prior to enrollment. Among HIV-1 infected partners, 41 % had
plasma viral load >50,000 copies/ml.
Conclusion: A risk scoring tool identified HIV-1 serodiscordant couples for a demonstration project of PrEP and ART
with high HIV-1 risk. The tool may be feasible for research and public health settings to maximize efficiency and
minimize HIV-1 prevention costs.
