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

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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.

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References

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  3. Joint United National Programme on HIV/AIDS (UNAIDS). Ambitious treatment targets: writing the final chapter of the AIDS epidemic, Geneva; 2014.

  4. Singh P, Sachs JD. 1 million community health workers in sub-Saharan Africa by 2015. Lancet. 2013;382(9889):363–5.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chigwedere P, Essex M. AIDS denialism and public health practice. AIDS Behav. 2010;14(2):237–47.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

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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).

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Authors and Affiliations

  1. Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Jennifer Manne-Goehler & Mark Siedner

  2. Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA

    Julia Rohr, Pascal Geldsetzer & Till W. Bärnighausen

  3. Harvard Center for Population & Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, USA

    Julia Rohr & Livia Montana

  4. Africa Health Research Institute (AHRI), Mtubatuba, South Africa

    Mark Siedner, Guy Harling & Till W. Bärnighausen

  5. Institute for Global Health, University College London, London, UK

    Guy Harling

  6. Medical Research Council/Wits Rural Public Health & Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa

    F. Xavier Gómez-Olivé, Ryan Wagner, Kathleen Kahn & Stephen Tollman

  7. INDEPTH Network, Accra, Ghana

    F. Xavier Gómez-Olivé, Ryan Wagner, Kathleen Kahn & Stephen Tollman

  8. Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    Lubbe Wiesner

  9. Institute of Public Health, University of Heidelberg, Heidelberg, Germany

    Till W. Bärnighausen

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  1. Jennifer Manne-Goehler
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  2. Julia Rohr
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  3. Livia Montana
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  4. Mark Siedner
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  6. F. Xavier Gómez-Olivé
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  7. Pascal Geldsetzer
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  9. Lubbe Wiesner
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  10. Kathleen Kahn
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  11. Stephen Tollman
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  12. Till W. Bärnighausen
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Correspondence to Jennifer Manne-Goehler.

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Manne-Goehler, J., Rohr, J., Montana, L. et al. ART Denial: Results of a Home-Based Study to Validate Self-reported Antiretroviral Use in Rural South Africa. AIDS Behav 23, 2072–2078 (2019). https://doi.org/10.1007/s10461-018-2351-7

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