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ART Denial: Results of a Home-Based Study to Validate Self-reported Antiretroviral Use in Rural South Africa

  • Jennifer Manne-Goehler
  • Julia Rohr
  • Livia Montana
  • Mark Siedner
  • Guy Harling
  • F. Xavier Gómez-Olivé
  • Pascal Geldsetzer
  • Ryan Wagner
  • Lubbe Wiesner
  • Kathleen Kahn
  • Stephen Tollman
  • Till W. Bärnighausen
Original Paper

Abstract

There is increasing interest in home based testing and treatment of HIV to expand access to treatment in sub-Saharan Africa. Such programs rely on self-reported HIV history and use of antiretroviral therapy (ART). However, the accuracy of self-reported ART use in community settings is not well described. In this study, we compared self-reported ART (SR-ART) use in a home based survey against biological exposure to ART (BE-ART), in a population study of older adults in South Africa. Health and Aging in Africa: a Longitudinal Study of an INDEPTH community in South Africa (HAALSI) is a cohort of adults aged 40 +. The baseline home-based interview included self-reported HIV status and ART use. All participants also underwent biological testing for HIV antibodies, viral load and exposure to emtricitabine (FTC) or lamivudine (3TC), which are included in all first-line and second-line ART regimens in the public-sector South African HIV program. We calculated the performance characteristics for SR-ART compared to BE-ART and fit multivariable logistic regression models to identify correlates of invalid SR-ART responses. Of 4560 HAALSI participants with a valid HIV test result available, 1048 (23%) were HIV-positive and 734 [70% of people living with HIV (PLWH)] were biologically validated ART users (BE-ART). The sensitivity of SR-ART use was 64% (95% CI 61–68%) and the specificity was 94% (95% CI 91–96%); the positive predictive value (PPV) was 96% (95% CI 94–98%) and negative predictive value (NPV) was 52% (95% CI 48–56%). We found no sociodemographic predictors of accurate SR-ART use. Over one in three individuals with detectable ART in their blood denied current ART use during a home-based interview. These results demonstrate ongoing stigma related to HIV and its treatment, and have important implications for community health worker programs, clinical programs, and research studies planning community-based ART initiation in the region.

Keywords

Antiretroviral therapy Home-based testing Self-report Validation 

Notes

Acknowledgements

We would like to thank The Division of Clinical Pharmacology Laboratory at the University of Cape Town for their assistance in performing tests of exposure to emtricitabine and lamivudine.

Funding

This work was supported by the National Institute of Aging at the National Institutes of Health (Grant Number 1P01AG041710-01A1, HAALSI—Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The HAALSI study is nested within the Agincourt Health and Socio-demographic Surveillance System site, funded by the University of the Witwatersrand and Medical Research Council, South Africa, and the Wellcome Trust, UK (058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z). Till Bärnighausen received funding from the Alexander von Humboldt Foundation through the Alexander von Humboldt professor award, which is financed by the German Federal Ministry of Education and Research; the European Commission; the Clinton Health Access Initiative: UNAIDS; and from NICHD of NIH (R01-HD084233), NIA of NIH (P01-AG041710), NIAID of NIH (R01-AI124389 and R01-AI112339) as well as FIC of NIH (D43-TW009775).

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

References

  1. 1.
    Bor J, Herbst AJ, Newell ML, Barnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science. 2013;339(6122):961–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Bor J, Tanser F, Newell ML, Barnighausen T. In a study of a population cohort in South Africa, HIV patients on antiretrovirals had nearly full recovery of employment. Health Aff. 2012;31(7):1459–69.CrossRefGoogle Scholar
  3. 3.
    Joint United National Programme on HIV/AIDS (UNAIDS). Ambitious treatment targets: writing the final chapter of the AIDS epidemic, Geneva; 2014.Google Scholar
  4. 4.
    Singh P, Sachs JD. 1 million community health workers in sub-Saharan Africa by 2015. Lancet. 2013;382(9889):363–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Labhardt ND, Ringera I, Lejone TI, et al. Effect of offering same-day ART vs usual health facility referral during home-based HIV testing on linkage to care and viral suppression among adults with HIV in Lesotho: the CASCADE randomized clinical trial. JAMA. 2018;319(11):1103–12.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Gaziano TA, Abrahams-Gessel S, Denman CA, et al. An assessment of community health workers’ ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: an observational study. Lancet Glob Health. 2015;3(9):e556–63.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    De Neve JW, Garrison-Desany H, Andrews KG, et al. Harmonization of community health worker programs for HIV: a four-country qualitative study in Southern Africa. PLoS Med. 2017;14(8):e1002374.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Grabowski MK, Reynolds SJ, Kagaayi J, et al. The validity of self-reported antiretroviral use in persons living with HIV: a population-based study. AIDS. 2018;32(3):363–9.PubMedGoogle Scholar
  9. 9.
    Kim AA, Mukui I, Young PW, et al. Undisclosed HIV infection and antiretroviral therapy use in the Kenya AIDS indicator survey 2012: relevance to national targets for HIV diagnosis and treatment. AIDS. 2016;30(17):2685–95.CrossRefPubMedGoogle Scholar
  10. 10.
    Rosenberg MS, Gomez-Olive FX, Rohr JK, et al. Sexual behaviors and HIV status: a population-based study among older adults in rural South Africa. J Acquir Immune Defic Syndr. 2017;74(1):e9–17.CrossRefPubMedGoogle Scholar
  11. 11.
    Gomez-Olive FX, Montana L, Wagner RG, et al. Cohort profile: health and ageing in Africa: a longitudinal study of an INDEPTH community in South Africa (HAALSI). Int J Epidemiol. 2018;47:689–90.CrossRefGoogle Scholar
  12. 12.
    Cornell M, Johnson LF, Schomaker M, et al. Age in antiretroviral therapy programmes in South Africa: a retrospective, multicentre, observational cohort study. Lancet HIV. 2015;2(9):e368–75.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Tollman SM, Herbst K, Garenne M, Gear JS, Kahn K. The Agincourt demographic and health study–site description, baseline findings and implications. S Afr Med J. 1999;89(8):858–64.PubMedGoogle Scholar
  14. 14.
    Kahn K, Collinson MA, Gomez-Olive FX, et al. Profile: agincourt health and socio-demographic surveillance system. Int J Epidemiol. 2012;41(4):988–1001.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Koal T, Burhenne H, Romling R, Svoboda M, Resch K, Kaever V. Quantification of antiretroviral drugs in dried blood spot samples by means of liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom. 2005;19(21):2995–3001.CrossRefPubMedGoogle Scholar
  16. 16.
    Rohr JK, Gómez-Olivé FX, Rosenberg M, Manne-Goehler J, Geldsetzer P, Wagner W, Houle B, Salomon J, Kahn K, Tollman S, Berkman L, Bärnighausen T. Performance of self-reported HIV status in determining true HIV status among older adults in rural South Africa: a validation study. J Int AIDS Soc. 2017;20:21691.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Chigwedere P, Essex M. AIDS denialism and public health practice. AIDS Behav. 2010;14(2):237–47.CrossRefPubMedGoogle Scholar
  18. 18.
    Johnston LG, McFarland W, Sabin ML, et al. Measuring self-reported HIV status in bio-behavioural surveys. Bull World Health Organ. 2015;93(5):287.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Kemp C, Gerth-Guyette E, Dube L, Andrasik M, Rao D. Mixed-methods evaluation of a novel, structured, community-based support and education intervention for individuals with HIV/AIDS in KwaZulu-Natal, South Africa. AIDS Behav. 2016;20(9):1937–50.CrossRefPubMedGoogle Scholar
  20. 20.
    Masquillier C, Wouters E, Mortelmans D, le Roux Booysen F. The impact of community support initiatives on the stigma experienced by people living with HIV/AIDS in South Africa. AIDS Behav. 2015;19(2):214–26.CrossRefPubMedGoogle Scholar
  21. 21.
    Weiser SD, Bukusi EA, Steinfeld RL, et al. Shamba Maisha: randomized controlled trial of an agricultural and finance intervention to improve HIV health outcomes. AIDS. 2015;29(14):1889–94.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Tsai AC, Hatcher AM, Bukusi EA, et al. A livelihood intervention to reduce the stigma of HIV in Rural Kenya: longitudinal qualitative study. AIDS Behav. 2017;21(1):248–60.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jennifer Manne-Goehler
    • 1
  • Julia Rohr
    • 2
    • 3
  • Livia Montana
    • 3
  • Mark Siedner
    • 1
    • 4
  • Guy Harling
    • 4
    • 5
  • F. Xavier Gómez-Olivé
    • 6
    • 7
  • Pascal Geldsetzer
    • 2
  • Ryan Wagner
    • 6
    • 7
  • Lubbe Wiesner
    • 8
  • Kathleen Kahn
    • 6
    • 7
  • Stephen Tollman
    • 6
    • 7
  • Till W. Bärnighausen
    • 2
    • 4
    • 9
  1. 1.Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Global Health and PopulationHarvard T. H. Chan School of Public HealthBostonUSA
  3. 3.Harvard Center for Population & Development StudiesHarvard UniversityCambridgeUSA
  4. 4.Africa Health Research Institute (AHRI)MtubatubaSouth Africa
  5. 5.Institute for Global HealthUniversity College LondonLondonUK
  6. 6.Medical Research Council/Wits Rural Public Health & Health Transitions Research Unit, School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
  7. 7.INDEPTH NetworkAccraGhana
  8. 8.Division of Clinical Pharmacology, Department of Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
  9. 9.Institute of Public HealthUniversity of HeidelbergHeidelbergGermany

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