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      Performance of self-reported HIV status in determining true HIV status among older adults in rural South Africa: a validation study

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          Abstract

          Introduction: In South Africa, older adults make up a growing proportion of people living with HIV. HIV programmes are likely to reach older South Africans in home-based interventions where testing is not always feasible. We evaluate the accuracy of self-reported HIV status, which may provide useful information for targeting interventions or offer an alternative to biomarker testing.

          Methods: Data were taken from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) baseline survey, which was conducted in rural Mpumalanga province, South Africa. A total of 5059 participants aged ≥40 years were interviewed from 2014 to 2015. Self-reported HIV status and dried bloodspots for HIV biomarker testing were obtained during at-home interviews. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for self-reported status compared to “gold standard” biomarker results. Log-binomial regression explored associations between demographic characteristics, antiretroviral therapy (ART) status and sensitivity of self-report.

          Results: Most participants (93%) consented to biomarker testing. Of those with biomarker results, 50.9% reported knowing their HIV status and accurately reported it. PPV of self-report was 94.1% (95% confidence interval (CI): 92.0–96.0), NPV was 87.2% (95% CI: 86.2–88.2), sensitivity was 51.2% (95% CI: 48.2–54.3) and specificity was 99.0% (95% CI: 98.7–99.4). Participants on ART were more likely to report their HIV-positive status, and participants reporting false-negatives were more likely to have older HIV tests.

          Conclusions: The majority of participants were willing to share their HIV status. False-negative reports were largely explained by lack of testing, suggesting HIV stigma is retreating in this setting, and that expansion of HIV testing and retesting is still needed in this population. In HIV interventions where testing is not possible, self-reported status should be considered as a routine first step to establish HIV status.

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          Most cited references 33

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          Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India.

          Using data from India, we estimate the relationship between household wealth and children's school enrollment. We proxy wealth by constructing a linear index from asset ownership indicators, using principal-components analysis to derive weights. In Indian data this index is robust to the assets included, and produces internally coherent results. State-level results correspond well to independent data on per capita output and poverty. To validate the method and to show that the asset index predicts enrollments as accurately as expenditures, or more so, we use data sets from Indonesia, Pakistan, and Nepal that contain information on both expenditures and assets. The results show large, variable wealth gaps in children's enrollment across Indian states. On average a "rich" child is 31 percentage points more likely to be enrolled than a "poor" child, but this gap varies from only 4.6 percentage points in Kerala to 38.2 in Uttar Pradesh and 42.6 in Bihar.
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            Diagnostic tests. 1: Sensitivity and specificity.

             J Bland,  D Altman (1994)
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              A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS.

              HIV/AIDS-related stigma and discrimination have a substantial impact on people living with HIV/AIDS (PLHA). The objectives of this study were: (1) to determine the associations of two constructs of HIV/AIDS-related stigma and discrimination (negative attitudes towards PLHA and perceived acts of discrimination towards PLHA) with previous history of HIV testing, knowledge of antiretroviral therapies (ARVs) and communication regarding HIV/AIDS and (2) to compare these two constructs across the five research sites with respect to differing levels of HIV prevalence and ARV coverage, using data presented from the baseline survey of U.S. National Institute of Mental Health (NIMH) Project Accept, a four-country HIV prevention trial in Sub-Saharan Africa (Tanzania, Zimbabwe and South Africa) and northern Thailand. A household probability sample of 14,203 participants completed a survey including a scale measuring HIV/AIDS-related stigma and discrimination. Logistic regression models determined the associations between negative attitudes and perceived discrimination with individual history of HIV testing, knowledge of ARVs and communication regarding HIV/AIDS. Spearman's correlation coefficients determined the relationships between negative attitudes and perceived discrimination and HIV prevalence and ARV coverage at the site-level. Negative attitudes were related to never having tested for HIV, lacking knowledge of ARVs, and never having discussed HIV/AIDS. More negative attitudes were found in sites with the lowest HIV prevalence (i.e., Tanzania and Thailand) and more perceived discrimination against PLHA was found in sites with the lowest ARV coverage (i.e., Tanzania and Zimbabwe). Programs that promote widespread HIV testing and discussion of HIV/AIDS, as well as education regarding and universal access to ARVs, may reduce HIV/AIDS-related stigma and discrimination.
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                Author and article information

                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                ZIAS
                zias20
                Journal of the International AIDS Society
                Taylor & Francis
                1758-2652
                2017
                18 July 2017
                : 20
                : 1
                Affiliations
                [ a ] Center for Population and Development Studies, Harvard University , Cambridge, MA, USA
                [ b ] MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa
                [ c ] INDEPTH Network , Accra, Ghana
                [ d ] Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington , Bloomington, IN, USA
                [ e ] Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University , Boston, MA, USA
                [ f ] Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA, USA
                [ g ] School of Demography, Australian National University , Canberra, Australia
                [ h ] CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder , Boulder, CO, USA
                [ i ] Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University , Umeå, Sweden
                [ j ] Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University , Boston, MA, USA
                [ k ] Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University , Boston, MA, USA
                [ l ] Africa Health Research Institute (AHRI) , Mtubatuba, South Africa, KwaZulu-Natal
                [ m ] Institute of Public Health, University of Heidelberg , Heidelberg, Germany
                Author notes
                [ § ]Corresponding author: Julia Rohr, Center for Population and Development Studies, Harvard University , 9 Bow Street, Cambridge, MA 02138, USA. Tel: (617) 384-7681. ( jkrohr@ 123456hsph.harvard.edu )
                Article
                1351215
                10.7448/IAS.20.1.21691
                5577734
                28782333
                © 2017 Rohr J et al; licensee International AIDS Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported (CC BY 3.0) License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 2, References: 50, Pages: 8
                Product
                Funding
                Funded by: National Institutes of Health 10.13039/100000002
                Award ID: R01-AI124389
                Funded by: National Institutes of Health 10.13039/100000002
                Award ID: P01-AG041710
                Funded by: National Institutes of Health 10.13039/100000002
                Award ID: R01-HD084233
                Funded by: Wellcome Trust 10.13039/100004440
                Award ID: 085477/B/08/Z
                Funded by: Wellcome Trust 10.13039/100004440
                Award ID: 069683/Z/02/Z
                Funded by: Wellcome Trust 10.13039/100004440
                Award ID: 058893/Z/99/A
                Funded by: Wellcome Trust 10.13039/100004440
                Award ID: 085477/Z/08/Z
                This study was funded by the National Institute on Aging (NIA) of the National Institutes of Health (NIH) [P01-AG041710] and is nested within the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) and funded by Wellcome Trust [058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z] with important contributions from the University of the Witwatersrand and the South African Medical Research Council. Till Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. He is also supported by the Wellcome Trust, the European Commission, the Clinton Health Access Initiative and NICHD of NIH [R01-HD084233], NIAID of NIH [R01-AI124389 and R01-AI112339] and FIC of NIH [D43-TW009775].
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