Browsing by Author "Rachel R Yorlets"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    Validity of self-report for ascertaining HIV status among circular migrants and permanent residents in South Africa: a cross-sectional, population-based analysis
    (2023-03) Rachel R Yorlets; Mark N Lurie; Carren Ginsburg; Joseph W Hogan; Nina R Joyce; Sadson Harawa; Mark A Collinson; F Xavier Gómez-Olivé; Michael J White
    While expanded HIV testing is needed in South Africa, increasing accurate self-report of HIV status is an essential parallel goal in this highly mobile population. If self-report can ascertain true HIV-positive status, persons with HIV (PWH) could be linked to life-saving care without the existing delays required by producing medical records or undergoing confirmatory testing, which are especially burdensome for the country’s high prevalence of circular migrants. We used Wave 1 data from The Migration and Health Follow-Up Study, a representative adult cohort, including circular migrants and permanent residents, randomly sampled from the Agincourt Health and Demographic Surveillance System in a rural area of Mpumalanga Province. Within the analytic sample (n=1,918), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of self-report were calculated with dried blood spot (DBS) HIV test results as the standard. Among in-person participants (n=2,468), 88.8% consented to DBS-HIV testing. HIV prevalence was 25.3%. Sensitivity of self-report was 43.9% (95% CI: 39.5–48.5), PPV was 93.4% (95% CI: 89.5–96.0); specificity was 99.0% (95% CI: 98.3–99.4) and NPV was 83.9% (95% CI: 82.8–84.9). Self-report of an HIV-positive status was predictive of true status for both migrants and permanent residents in this high-prevalence setting. Persons who self-reported as living with HIV were almost always truly positive, supporting a change to clinical protocol to immediately connect persons who say they are HIV-positive to ART and counselling. However, 56% of PWH did not report as HIV-positive, highlighting the imperative to address barriers to disclosure.