{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T14:36:00Z","timestamp":1777300560685,"version":"3.51.4"},"reference-count":48,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Indonesia has an escalated HIV epidemic among key populations, especially men who have sex with men (MSM). Diagnosis and immediate treatment of acute HIV infection (AHI), the earliest phase with the highest transmission risk, is beneficial for individual health and can reduce onward transmission. To inform whom to test for possible AHI using targeted, risk\u2010stratified HIV\u2010PCR testing, this study evaluated the performance of the validated, seven\u2010item Amsterdam AHI risk score among Indonesian MSM, and developed a locally optimized score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used the INTERACT prospective cohort of MSM (\u226516 years) attending sexual health clinics in Jakarta and Bali (May 2023\u2212February 2025) who were tested with add\u2010on Xpert HIV\u2010PCR (Cepheid) if their HIV antibody rapid testing was negative or inconclusive. We used generalized estimating equation models to generate risk scores, combining symptoms, risk factors and socio\u2010demographics. The optimized risk score was internally validated using bootstrap resampling. We calculated area under the curve (AUC), sensitivity and specificity (ISRCTN41396071).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1887 individuals, 20 were diagnosed with AHI, and 1867 tested AHI negative across 3446 test visits. The Amsterdam score yielded an AUC of 0.82 (95% CI 0.75\u22120.90) with a sensitivity of 85.0% (64.0%\u221294.8%) and a specificity of 59.2% (57.5\u221260.8). The optimized risk score included one symptom (fever &lt;2 weeks), one risk factor (condomless receptive anal intercourse &lt;6 months) and two socio\u2010demographic characteristics (age 16\u201330 years, not having received higher education), and achieved an AUC of 0.91 (0.87\u22120.96) with a sensitivity of 100% (83.9\u2212100) and a specificity of 65.3% (63.6%\u221266.8%). Internal validation yielded an AUC of 0.86 (0.67\u22120.97). Applying this risk score would classify 35.1% of MSM as eligible for add\u2010on HIV\u2010PCR testing, identifying 83.9%\u2013100% of individuals who have AHI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This four\u2010item risk score of easily collected variables can facilitate efficient AHI detection in high\u2010yield clinic settings, enhancing opportunities for HIV prevention. In the Indonesian context, younger MSM with lower educational attainment were particularly vulnerable to AHI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70111","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T06:59:18Z","timestamp":1776322758000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Four\u2010Item Risk Score to Target Acute HIV Infection Testing Among Men Who Have Sex With Men in Indonesia: Development and Validation in the INTERACT Prospective Cohort"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3605-6167","authenticated-orcid":false,"given":"Gilbert","family":"Lazarus","sequence":"first","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia Faculty of Medicine Universitas Indonesia Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8018-0528","authenticated-orcid":false,"given":"Nurhayati H.","family":"Kawi","sequence":"additional","affiliation":[{"name":"Klinik Utama Globalindo  Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1669-5818","authenticated-orcid":false,"given":"Hendry","family":"Luis","sequence":"additional","affiliation":[{"name":"Yayasan Bali Peduli  Denpasar Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7618-4537","authenticated-orcid":false,"given":"Dwi P.","family":"Rahmawati","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia Faculty of Medicine Universitas Indonesia Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1564-7926","authenticated-orcid":false,"given":"Erik P.","family":"Sihotang","sequence":"additional","affiliation":[{"name":"Klinik Utama Globalindo  Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margareta","family":"Oktaviani","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia Faculty of Medicine Universitas Indonesia Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2926-0856","authenticated-orcid":false,"given":"Pande Putu","family":"Januraga","sequence":"additional","affiliation":[{"name":"Center for Public Health Innovation Udayana University  Denpasar Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4726-7998","authenticated-orcid":false,"family":"Suwarti","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia Faculty of Medicine Universitas Indonesia Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8885-7823","authenticated-orcid":false,"given":"Evi","family":"Sukmaningrum","sequence":"additional","affiliation":[{"name":"Faculty of Psychology Atma Jaya Catholic University of Indonesia  Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6650-0559","authenticated-orcid":false,"given":"Evy","family":"Yunihastuti","sequence":"additional","affiliation":[{"name":"Dr Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2561-7659","authenticated-orcid":false,"given":"Maartje","family":"Dijkstra","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Amsterdam University Medical Centers University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1062-8921","authenticated-orcid":false,"given":"Eduard J.","family":"Sanders","sequence":"additional","affiliation":[{"name":"The Aurum Institute  Johannesburg South Africa"},{"name":"Sir William Dunn School of Pathology University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4942-1626","authenticated-orcid":false,"given":"Frank Stephen","family":"Wignall","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia Faculty of Medicine Universitas Indonesia Jakarta Indonesia"},{"name":"Klinik Utama Globalindo  Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5797-8216","authenticated-orcid":false,"given":"Keerti","family":"Gedela","sequence":"additional","affiliation":[{"name":"56 Dean Street Clinic Chelsea &amp; Westminster Hospital NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1298-8744","authenticated-orcid":false,"family":"Irwanto","sequence":"additional","affiliation":[{"name":"Faculty of Psychology Atma Jaya Catholic University of Indonesia  Jakarta Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5007-7896","authenticated-orcid":false,"given":"Raph L.","family":"Hamers","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia Faculty of Medicine Universitas Indonesia Jakarta Indonesia"},{"name":"Centre for Tropical Medicine and Global Health Nuffield Department of Medicine University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the INTERACT Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.1.21579"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1011874"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60842-8"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idm.2019.04.001"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000121"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000616"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2017.06.006"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26463"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000193"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.1.21708"},{"key":"e_1_2_14_12_1","unstructured":"UNAIDS DATA2024.2024."},{"key":"e_1_2_14_13_1","volume-title":"2023 Integrated Biological and Behavioral Surveillance (IBBS) on HIV Key Population","author":"Ministry of Health Republic Indonesia","year":"2024"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26386"},{"key":"e_1_2_14_15_1","volume-title":"Laporan eksekutif perkembangan HIV AIDS dan penyakit infeksi menular seksual (PIMS) periode Januari\u2010Desember tahun 2024","year":"2024"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0956462420966838"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0956462420949795"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25590"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2508-4"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000003519"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010107\u20104\u2010474"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa505"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ335"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.5954"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-024-02198-2"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-074819"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283629095"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000924"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-018-2141-2"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-058636"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz895"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000596"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-014-0921-x"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq057"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.101033"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03347-0"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-017-1963-7"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.2147\/HIV.S176826"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2020-054706"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa306"},{"issue":"1","key":"e_1_2_14_41_1","first-page":"1","article-title":"CDC Laboratory Recommendations for Syphilis Testing, United States, 2024","volume":"73","author":"Papp J. 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