Send to

Choose Destination
AIDS Behav. 2018 Dec 6. doi: 10.1007/s10461-018-2351-7. [Epub ahead of print]

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

Author information

Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA.
Harvard Center for Population & Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, USA.
Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Africa Health Research Institute (AHRI), Mtubatuba, South Africa.
Institute for Global Health, University College London, London, UK.
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.
INDEPTH Network, Accra, Ghana.
Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.


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.


Antiretroviral therapy; Home-based testing; Self-report; Validation


Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center