The Mozambique Indicators of Immunization, Malaria and HIV/AIDS (IMASIDA) survey was conducted in 2015 and used a two Enzyme Immunoassay (EIA) (Vironostika HIV-1/2 and Murex HIV-1/2) based algorithm to determine the HIV status of the consented participants. The Mozambique Ministry of Health, with support from the US Centers for Disease Control and Prevention (US CDC), added Bio-Rad Geenius™ HIV-1/2 Supplemental Assay to the IMASIDA HIV testing algorithm to confirm all specimens that were found to be reactive on one or both EIAs. In total 11690 specimens were collected to estimate the proportion of HIV positive samples. Results indicate that the proportion of HIV positive samples based on the concordant positive results of two EIA assays was 21.5% (2518/11690). The addition of the Geenius assay to the IMASIDA HIV testing algorithm demonstrated that 792 (31.5%) of 2518 specimens were false-positive and reduced the proportion of HIV positive samples to 14.7% (1722/11690), demonstrating the importance of including a highly specific HIV test to confirm HIV diagnosis. HIV surveys exclusively based on EIA testing algorithm may result in misleading high prevalence results. Our results demonstrate that more specific confirmatory testing should be added to the EIA-based algorithms to ensure accurate HIV diagnosis and correct HIV prevalence estimate in cross-sectional surveys.
Methods We conducted qualitative interviews with 30 PLHIV with hazardous alcohol use from an antiretroviral therapy (ART) clinic in the Thai Nguyen to inform item development. Alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). We tested items in a quantitative survey of 1,559 ART clinic patients in Thai Nguyen to assess internal reliability (Cronbach's a) and structural validity (exploratory factor analysis, EFA). We used binomial logistic regression to estimate associations between AAS (median score >7) and alcohol use. Results Using the results from the qualitative interview data, we developed the AAS scale with seven final items covering internalized, experience, and anticipated stigma, with scores ranging from 7 to 35. The scale had good internal consistency (a=0.75). EFA suggested the presence of two factors (r=0.42) that explained 64.5% of the total variance. Overall, the median AAS score was 7 (IQR:7-11). Those with alcohol dependence symptoms (AUDIT!20) reported high levels of AAS (median=9, IQR:7-14) and non-harmful alcohol users (AUDIT<8) reported lower levels of AAS (median=7, IQR:7-9). AAS was significantly associated with alcohol dependency, (adjusted prevalence ratio APR =1.74, 95%CI: 1.53,1.99), adjusting for age, gender, and employment status. Conclusion The AAS scale may be utilized or adopted to measure of alcohol abstinence stigma among PLHIV in settings where alcohol us is culturally encouraged. This new measure will aid future studies assessing the value of developing culturally sensitive strategies to reduce alcohol consumption and ultimately improving HIV treatment outcomes among PLHIV. Disclosure No significant relationships.
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