Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2020 Mar;23(3):e25457. doi: 10.1002/jia2.25457.
Although HIV prevalence is exceptionally high in South Africa, HIV testing rates remain below targeted guidelines. Older adults living with HIV are substantially more likely to remain undiagnosed than younger people. Cognitive function and literacy could play key roles in HIV status knowledge due to the decision-making processes required around weighing the costs and benefits of testing, navigating testing logistics and processing results. We aimed to assess the independent relationships among each of cognitive function, literacy and education with HIV status knowledge in a population-based sample of older adults living in a rural South African community with high HIV prevalence.
We analyzed data from a population-based study of 5059 men and women aged 40 years and older in rural South Africa (Health and Aging in Africa: A Longitudinal Study of an INDEPTH community (HAALSI)). HAALSI surveys, conducted between 2014 and 2015, queried self-reported literacy, educational attainment and HIV status knowledge. Laboratory tests were conducted to assess true HIV sero-status. Cognitive function was assessed with a battery of cognitive tests measuring time orientation, immediate and delayed recall, and numeracy and coded using confirmatory factor analysis as a z-standardized latent variable. We estimated the relationship between the outcome of HIV status knowledge and each of three exposures: (1) latent cognitive z-score, (2) literacy and (3) education, using confounder-adjusted modified Poisson regression models in the study population overall and stratified by HIV sero-status.
We found that HIV status knowledge was higher among those with higher cognitive z-scores (adjusted Prevalence Ratio (aPR) (95% CI): 1.18 (1.14, 1.21) per standard deviation unit), and among literate participants (aPR (95% CI): 1.24 (1.16, 1.32) vs. non-literate participants). Taken together, the associations with literacy and cognitive function completely attenuated the otherwise positive association between educational attainment and HIV status knowledge. The magnitudes of effect were generally similar among laboratory-confirmed HIV-negative and HIV-positive participants.
Campaigns that target older adults in rural South Africa with HIV testing messages should carefully consider the cognitive and literacy levels of the intended audience. Innovations to ease the cognitive load associated with HIV testing could prove fruitful to increase HIV status knowledge.
尽管南非的艾滋病毒感染率异常高，但艾滋病毒检测率仍低于目标指导方针。与年轻人相比，感染艾滋病毒的老年人更有可能未被发现。由于需要权衡检测的成本和收益、处理检测结果等决策过程，认知功能和读写能力可能在艾滋病毒状况知识方面发挥关键作用。我们旨在评估认知功能、读写能力和教育程度与在南非农村社区进行的基于人群的艾滋病毒流行地区的老年人群体中艾滋病毒状况知识之间的独立关系。
我们分析了南非农村地区（健康与衰老在非洲：一项深入社区的纵向研究（HAALSI））的一项基于人群的研究中的 5059 名 40 岁及以上男性和女性的数据。HAALSI 调查于 2014 年至 2015 年进行，询问了自我报告的读写能力、教育程度和艾滋病毒状况知识。进行实验室测试以评估真实的艾滋病毒血清状况。认知功能通过一系列认知测试进行评估，这些测试测量时间定向、即时和延迟回忆以及计算能力，并使用确认性因素分析编码为标准分数的潜在变量。我们使用研究人群中的混杂因素调整后的改良泊松回归模型，估计了结局（即艾滋病毒状况知识）与三种暴露因素（1）潜在认知 z 分数，（2）读写能力和（3）教育之间的关系，并根据艾滋病毒血清状况进行分层。
我们发现，认知 z 分数较高者的艾滋病毒状况知识较高（调整后的患病率比（aPR）（95%CI）：每标准偏差单位 1.18（1.14，1.21）），而读写能力较高者的 aPR（95%CI）：1.24（1.16，1.32）与非读写能力者相比。综合来看，读写能力和认知功能的关联完全削弱了教育程度与艾滋病毒状况知识之间的正向关联。实验室确认的 HIV 阴性和 HIV 阳性参与者的效应大小大致相似。
针对南非农村地区的老年人群体开展的艾滋病毒检测宣传活动应仔细考虑目标受众的认知和读写水平。为减轻与艾滋病毒检测相关的认知负担而进行的创新可能会增加艾滋病毒状况知识。
