ArticleEClinicalMedicine2025
Diagnostic performance of HIV risk assessment tools for identifying pre-exposure prophylaxis candidates: a systematic review and meta-analysis.
Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Guideline
- Canadian guideline on HIV pre- and postexposure prophylaxis: 2025 update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2025Guideline
- Reducing inequities in access to postpartum hemorrhage prevention: Reframing advance distribution of misoprostol as a test case for health system responsiveness and adaptation.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: To support the implementation of HIV pre-exposure prophylaxis (PrEP), we conducted a systematic review and meta-analysis evaluating the diagnostic performance of HIV risk assessment tools in predicting HIV infection. Methods: We searched MEDLINE, Embase, and CINAHL for observational studies published between January 1, 1998, and May 13, 2024 that reported on the diagnostic performance of HIV risk assessment tools. We calculated pooled area under the curve (pAUC) values using inverse variance methods, with sensitivity and specificity reported at common cutoffs (PROSPERO registration number: CRD42024543975). Findings: Of 3704 publications, 27 met our criteria. Twelve studies on men who have sex with men (MSM) assessed nine tools, with four extensively validated, predominantly in U.S. populations. SexPro exhibited the highest performance (pAUC: 0.75), while HIRI-MSM (pAUC: 0.69), Menza (pAUC: 0.63), and SDET (pAUC: 0.66) demonstrated moderate predictive ability, with considerable heterogeneity. For cisgender women, twelve African studies evaluated six tools, with VOICE being the only extensively validated tool (pAUC: 0.65 for adult females; 0.62 for adolescent and young women). Although additional tools were available for subgroups within Africa, there were no tools for cisgender women outside Africa. Among other populations, DHRS demonstrated good discrimination for general U.S. adults (pAUC: 0.80), as did the HIV Prevalence Risk Score for African mixed populations (AUC: 0.70), Kahle for heterosexual serodiscordant couples in Africa (pAUC: 0.73), and ARCH-IDU for people who use drugs in the U.S. (pAUC: 0.72). Sensitivity and specificity varied by cutoffs. Tool items fell into six domains: sexual activities, substance use, clinical factors, demographics, reproductive health, and other factors, with complexity differing by population and context. Interpretation: Validated tools can help identify HIV risk in some populations, but tools are still needed to promote equitable PrEP access for subpopulations such as cisgender women outside Africa. Public health programs and clinicians should consider incorporating up-to-date, local data to enhance the relevance and effectiveness of existing tools. Funding: This work was supported by the Canadian Institutes of Health Research (Grant number PCS - 183410). DHST is supported by a Tier 2 Canada Research Chair in Biomedical HIV/STI Prevention.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.