People Who Self-Reported Testing HIV-Positive but Tested HIV-Negative: A Multi-Country Puzzle of Data, Serology, and...

Area of Science:

• Epidemiology
• Public Health
• Infectious Disease Research

Background:

• Population-based HIV impact assessments (PHIAs) rely on accurate self-reported and tested HIV status.
• Discrepancies arise when participants self-reporting HIV-positive status (PSRP) test negative in surveys, questioning data validity.

Purpose of the Study:

• To analyze discrepancies in HIV testing among participants who self-reported HIV-positive status but tested negative in PHIAs.
• To assess the impact of these discrepancies on HIV prevalence and viral load suppression estimates.
• To explore reasons for these discrepancies beyond misdiagnosis or false reporting.

Main Methods:

• Analysis of data from 19,026 PSRP participants (aged 15-59) across 13 countries (2015-2021).
• Inclusion of survey HIV status, viral load, rapid and confirmatory test results, and follow-up data (e.g., years on treatment).
• Detailed examination of 107 PSRP with negative results in Uganda.

Main Results:

• 256 (1.3%) of PSRP were determined to be HIV-negative after further testing and review.
• The number of PSRP testing HIV-negative was too small to significantly impact overall HIV prevalence or viral load suppression estimates.
• No significant correlation found between negative test results in PSRP and years on treatment or age in the Ugandan subset.

Conclusions:

• The small proportion of PSRP testing HIV-negative suggests that accepting self-reported status without testing would not significantly skew prevalence estimates.
• Understanding the nuances of HIV testing behaviors among PSRP is crucial for ethical survey conduct and high-quality data.
• Further investigation into reasons for discrepancies, beyond misdiagnosis, is warranted.