Citation
Leslie, Hannah H.; Kabudula, Chodziwadziwa W.; West, Rebecca L.; Kang Dufour, Mi-Suk; Julien, Aimée; Masilela, Nkosinathi G.; Tollman, Stephen M.; Pettifor, Audrey E.; Kahn, Kathleen; & Lippman, Sheri A. (2023). Estimating the Prevalence of over- and under-Reporting in HIV Testing, Status and Treatment in Rural Northeast South Africa: A Comparison of a Survey and Clinic Records. AIDS and Behavior, 27(10), 3248-3257. PMCID: PMC10066974Abstract
We assess the accuracy of self-reported testing, HIV status, and treatment responses compared to clinical records in Ehlanzeni District, South Africa. We linked a 2018 population-based survey of adults 18-49 years old with clinical data at local primary healthcare facilities from 2014 to 2018. We calculated self-reported testing, HIV status, and treatment, and triangulated findings with clinic record data. We adjusted testing estimates for known gaps in HIV test documentation. Of 2089 survey participants, 1657 used a study facility and were eligible for analysis. Half of men and 84% of women reported an HIV test in the past year. One third of reported tests could be confirmed in clinic data within 1 year and an additional 13% within 2 years; these fractions increased to 57% and 22% respectively limiting to participants with a verified clinic file. After accounting for gaps in clinic documentation, we found that prevalence of recent HIV testing was closer to 15% among men and 51% in women. Estimated prevalence of known HIV was 16.2% based on self-report vs. 27.6% with clinic documentation. Relative to clinical records among confirmed clinic users, self report of HIV testing and of current treatment were highly sensitive but non-specific (sensitivity 95.5% and 98.8%, specificity 24.2% and 16.1% respectively), while self report of HIV status was highly specific but not sensitive (sensitivity 53.0%, specificity 99.3%). While clinical records are imperfect, survey-based measures should be interpreted with caution in this rural South African setting.URL
http://dx.doi.org/10.1007/s10461-023-04045-9Reference Type
Journal ArticleYear Published
2023Journal Title
AIDS and BehaviorAuthor(s)
Leslie, Hannah H.Kabudula, Chodziwadziwa W.
West, Rebecca L.
Kang Dufour, Mi-Suk
Julien, Aimée
Masilela, Nkosinathi G.
Tollman, Stephen M.
Pettifor, Audrey E.
Kahn, Kathleen
Lippman, Sheri A.