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Validity of Self-Report for Ascertaining HIV Status Among Circular Migrants and Permanent Residents in South Africa: A Cross-Sectional, Population-Based Analysis

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Abstract

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.

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Acknowledgements

This work would not be possible without the fieldworkers, respondents, and community of the Agincourt sub-district of Mpumalanga province, South Africa. We thank Daniel Ohene-Kwofie, MS (University of the Witwatersrand School of Public Health) and Hong Xia, MS (Population Studies and Training Center, Brown University) for data management.

Funding

This study (‘Migration, Urbanization, and Health in a Transition Setting’) was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (1R01HD083374-01A1) and acknowledges support from the Population Studies and Training Center at Brown University (2P2CHD041020 -21). During these analyses, RRY was supported by a pre-doctoral fellowship through the Population Studies and Training Center at Brown University funded by the National Institute of Child Health and Human Development (T32 HD007338) and a pre-doctoral fellowship through the National Institutes of Health (5T32MH078788-12). Her work was facilitated by the Providence/Boston Center for AIDS Research (P30AI042853). The MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) acknowledges funding from The Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z), and the Medical Research Council, South Africa.

Conflict of interest

The authors have no conflicts to disclose.

Ethics approval

The Migration and Health Follow-Up Study received ethics clearance from the Mpumalanga Research and Ethics Committee, the University of the Witwatersrand Human Research Ethics Committee (Medical, clearance certificate #M170277), and Institutional Review Board Authorization Agreement #17–46 with Brown University. Written informed consent was obtained for in-person interviews and DBS-HIV testing. Verbal consent was obtained for telephone interviews.

Consent to participate

Written informed consent was obtained for in-person interviews and DBS-HIV testing. Verbal consent was obtained for telephone interviews.

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Not applicable.

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    Authors and Affiliations

    1. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

      Rachel R Yorlets, Mark N Lurie & Nina R Joyce

    2. Population Studies and Training Center, Brown University, Providence, RI, USA

      Rachel R Yorlets, Mark N Lurie, Nina R Joyce & Michael J White

    3. Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng province, South Africa

      Carren Ginsburg, Sadson Harawa, Mark A Collinson, F Xavier Gómez-Olivé & Michael J White

    4. Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA

      Joseph W Hogan

    5. Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA

      Nina R Joyce

    6. South African Population Infrastructure Network (SAPRIN), South African Medical Research Council (SAMRC), Durban, South Africa

      Mark A Collinson

    7. Department of Sociology, Brown University, Providence, RI, USA

      Michael J White

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    Contributions

    RRY conducted analyses and drafted the manuscript. MNL supervised writing and analyses. MNL, CG, MAC, FXGO, and MJW conceived of the study and are co-investigators on The Migration and Health Follow-Up Study (MJW is the PI). JWH advised analyses. NRJ advised analyses and provided critical edits. SH is the field Project Site Manager for MHFUS, and provided field project leadership including training field workers, as well as data collection and management with the support of the research team. All authors reviewed and provided critical revisions to the manuscript.

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    Correspondence to Rachel R Yorlets.

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    The original online version of this article was revised: “Gomez-Olive and White are co-senior authors and Table 4’s title should have ‘PWH’ as the acronym in the title, not ‘PLWH’”

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    Yorlets, R.R., Lurie, M.N., Ginsburg, C. et al. Validity of Self-Report for Ascertaining HIV Status Among Circular Migrants and Permanent Residents in South Africa: A Cross-Sectional, Population-Based Analysis. AIDS Behav 27, 919–927 (2023). https://doi.org/10.1007/s10461-022-03828-w

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