Development and Evaluation of Short-Form Measures of the HIV/AIDS Knowledge Assessment Tool Among Sexual and Gender Minorities in Brazil: Cross-sectional Study

Abstract

Background In theoretical models of health behavior, knowledge about disease transmission and self-protective behaviors are conceptualized as important drivers of behavior change. Several studies conducted in Brazil point to an unfortunate convergence of sexual and gender minority (SGM) populations with low levels of HIV knowledge and younger age, lower education, engagement in higher-risk sexual behavior, and never having tested for HIV. Measures to assess level of HIV knowledge have been previously published, including the 12-item HIV/AIDS Knowledge Assessment (HIV-KA) tool. However, measure length can be a barrier to assessment. Objective We started from the 12-item HIV-KA tool and developed candidate short forms using statistical procedures, evaluated their psychometric properties, and tested the equivalency of their associations with other measures of HIV knowledge compared to the 12-item version. Methods A convenience sample of SGM was recruited during September 2020 to complete an online survey through advertisements on two social networking apps (Grindr and Hornet). The survey instrument included items on sociodemographic information, prior HIV testing and HIV test results, preexposure prophylaxis (PrEP) and antiretroviral treatment use, sexual behavior, and 3 HIV knowledge measures: the HIV-KA, World Health Organization Knowledge About HIV Transmission Prevention Indicator, and the Brief HIV Knowledge Questionnaire. We used exploratory factor analysis and confirmatory factor analysis (CFA) to assess the factor structure of the of the HIV-KA. We used optimal test assembly (OTA) methods to develop candidate short forms of the HIV-KA and evaluated them based on prespecified reliability, concurrent validity, and statistically equivalent convergent validity criteria. Results Among 2552 SGM individuals from Brazil, mean age was 35.1 years, 98.2% (2507/2552) cisgender men and 1.8% (45/2552) transgender/nonbinary, 56.5% (1441/2552) White, and 31.0% (792/2552) self-reported HIV positive. CFA indicated a 1-factor structure for the 12-item HIV-KA. Concurrent validity correlations were high for all short forms with 6 items, but only versions with 9 items were as reliable as the full-length form and demonstrated equivalency for convergent validity correlations. Suggesting post hoc convergent validity, HIV knowledge scores using the 9- and 10-item short forms were higher for participants who perceived the Undetectable Equals Untransmittable (U=U) slogan as completely accurate versus not accurate. Suggesting post hoc concurrent validity, participants of younger age, of Black, Pardo or indigenous race, and reporting lower education and lower income scored lower on HIV knowledge. Participants who never tested for HIV scored lower than those who tested negative or positive, while those currently using PrEP scored higher than those reporting past or never use. Conclusions OTA methods were used to shorten the 12-item HIV-KA to 9-item and 10-item versions while maintaining comparable reliability and validity among a large sample of Brazilian SGM. However, these short forms did not shorten sufficiently to justify deviation from the full measure.

Knowledge of HIV transmission, prevention strategies and U = U among adult sexual and gender minorities in Brazil

“…Section 3 included items of the HIV knowledge assessment tool (HIV‐KA), a 12‐item measure previously validated by our team using the same study design and target population as in this study [ 25 ] and previously used to assess knowledge among MSM in Brazil [ 18 ]. Items address aspects of HIV transmission, prevention or treatment (all items provided in Table S1 ).…”

“…This instrument includes three questions that should be answered as Yes, No or I don't remember, with individuals being classified as adherent (yes vs. no) if they answer "No" to all three questions. Section 3 included items of the HIV knowledge assessment tool (HIV-KA), a 12-item measure previously validated by our team using the same study design and target population as in this study [25] and previously used to assess knowledge among MSM in Brazil [18]. Items address aspects of HIV transmission, prevention or treatment (all items provided in Table S1).…”

Comparing Web-Based Venues to Recruit Gay, Bisexual, and Other Cisgender Men Who Have Sex With Men to a Large HIV Prevention Service in Brazil: Evaluation Study

“…Hornet and Grindr are popular among MSM in Brazil, and recruitment using these GSN apps has been used in previous cross-sectional studies conducted in the country [5,9,13,14,17,18]. We used direct inbox messages and banners to advertise on Hornet and Grindr, respectively.…”

Distribuição espacial e tendência temporal da AIDS no Brasil e regiões entre 2005 e 2020

“…No Brasil, em 2020, foram diagnosticados aproximadamente 29 mil casos de AIDS, sendo 10.417 óbitos por essa causa 4 . O perfil epidêmico brasileiro segue um padrão global, em que a prevalência é maior para grupos populacionais específicos como gays, bissexuais, homossexuais e mulheres transgênero 5 .…”