Oral Abstract Submission
Background : In 2019, Fulton County, GA was named one of 48 priority “hotspots” to target in renewed efforts to end the HIV epidemic in the U.S. To more accurately predict women at greatest risk for HIV, we conducted an individually-matched case control study among women who attended a Fulton County health clinic to identify risk factors associated with HIV seroconversion.
Methods : We obtained data about women who sought care at Fulton County Board of Health Sexual Health Clinic (SHC) between 2011-2016. Cases were women with at least one clinician-assisted visit (CAV) at the SHC prior to HIV diagnosis date. Controls were women who visited the clinic in this same period but remained HIV negative. Controls were individually matched to cases in a 2:1 matching ratio on race, age at first CAV, and date of first CAV. Conditional logistic regression was used to develop a model for predicting probability of and identifying risk factors for HIV seroconversion.
Results : Of 18,281 women who were HIV negative at their first visit to the SHC between 2011-2016, 110 (0.6%) seroconverted before 2018. Of these, 80 (73%) had a CAV prior to HIV diagnosis. Using these 80 cases and 160 matched controls, having a history of gonorrhea, multiple gonorrhea episodes, a history of syphilis, a greater number of sex partners in the past 2 months, anal sex, history of injection drug or crack cocaine use, a history of exchanging drugs/money for sex, and heterosexual sex with more than one sex partner in the last month were associated with HIV seroconversion in bivariate analyses. After conducting backward selection from a fully adjusted model, predictors remaining were: having a history of syphilis (OR=4.9, 95% CI: 1.4, 16.9), anal sex (OR=2.9, 95% CI: 1.0, 8.3), and injection drug or crack cocaine use (OR=34.8, 95% CI: 3.7, 328.1). Women having all three risk factors were six times more likely to seroconvert compared to matched controls without these risk factors.
Conclusion : Our results offer clinical insights into which women are most at-risk for HIV and are therefore best candidates for initiating HIV prevention interventions like pre-exposure prophylaxis (PrEP) within a HIV “hotspot” in the South.