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 serodis-
cordant couples with a high likelihood of pregnancy within one year.
Methods
Using standardized clinical prediction methods, we developed and validated a tool to iden-
tify 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 pre-
vention 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.
Discussion
A pregnancy likelihood score encompassing basic demographic, clinical and behavioral
factors defined African HIV-1 serodiscordant couples with high one-year pregnancy inci-
dence rates. This tool could be used to engage African HIV-1 serodiscordant couples in
counseling discussions about fertility intentions in order to offer services for safer concep-
tion or contraception that align with their reproductive goals.
