College of Nursing, Wayne State University, 5557 Cass Ave., 319 Cohn Bldg, Detroit, MI, 48202, USA.
Centre for Social and Behaviour Change, Ashoka University, Rajiv Gandhi Education City, Sonipat, Haryana, India.
Curr HIV/AIDS Rep. 2021 Aug;18(4):365-376. doi: 10.1007/s11904-021-00560-3. Epub 2021 May 16.
In this manuscript, we present recent findings concerning concordance and discrepancy between biological measures and self-reports of these three outcomes of HIV programs: HIV status, adherence to antiretroviral medications (ARVs) and use of and adherence to pre-exposure prophylaxis medication (PrEP), and condom use/unprotected sex.
Recent studies suggest that three successive rapid HIV tests (for those whose first test in positive) might be reasonably inexpensive and valid biological data to collect to combine with self-reports of HIV status, dried blood spots sufficiently affordable to combine with self-reports of adherence to ARVs and use of or adherence to PrEP, and that the discrepancy between self-reports of condom use and biomarkers of unprotected sex may be relatively small in high-income countries. Additional work on assessment of incorrect condom usage and breakage, standardized self-report measures of condom use, and more private data collection methodologies in low-income settings might reduce the recent observed discrepancies even further. Concordance between self-reports of HIV and biomarkers indicating HIV positive status has varied considerably, with much lower rates in low-income countries, where the stigma of HIV is still very high. Recommendation is for combining self-report data with the results of three successive rapid tests for those testing positive. For adherence, again agreement between self-reports and a variety of more objective and/or biological measures is only moderate. Dried blood spots (DBS) may be sufficiently inexpensive in low-resource settings that this may be the best biological method to combine with self-reports. In publications over the last 8 years, the discrepancy between self-reports of condom use and biomarkers for unprotected sex may be even lower than 20% after controlling for other features of the study, particularly in high-income countries. Our results suggest that more careful assessment of incorrect condom use and breakage as reasons other than intentional misreporting should be investigated more carefully and that more private data collection methods such as audio, computer-assisted self-interviewing (ACASI) might be employed more often in low-resource settings to reduce this discrepancy in those settings further. In addition, further analysis of the discrepancy between self-reports of condom use and biomarkers should be conducted of published studies using the correct calculation methods to be more certain of these findings.
在本文中，我们介绍了关于 HIV 项目三个结果（HIV 状态、抗逆转录病毒药物（ARV）的依从性、暴露前预防药物（PrEP）的使用和依从性以及避孕套的使用/无保护性行为）的生物测量和自我报告之间的一致性和差异的最新发现。
最近的研究表明，对于那些首次检测呈阳性的人，连续进行三次快速 HIV 检测可能是一种合理的、廉价的、有效的收集生物数据的方法，结合 HIV 状态的自我报告，使用和依从性检测以及使用和依从性检测，而在高收入国家，避孕套使用的自我报告和无保护性行为的生物标志物之间的差异可能相对较小。在低收入国家，进一步开展关于不正确使用避孕套和避孕套破裂的评估、标准化的避孕套使用自我报告措施以及更私密的数据收集方法，可能会进一步减少最近观察到的差异。HIV 自我报告和表明 HIV 阳性状态的生物标志物之间的一致性差异很大，在低收入国家的比例要低得多，而 HIV 的耻辱感仍然非常高。建议对检测呈阳性的人，将自我报告数据与连续三次快速检测的结果相结合。对于依从性，自我报告与各种更客观和/或生物测量之间的一致性也只是中等。在资源匮乏的环境中，干血斑（DBS）可能足够便宜，这可能是与自我报告相结合的最佳生物方法。在过去 8 年的出版物中，在控制研究的其他特征后，避孕套使用的自我报告和无保护性行为的生物标志物之间的差异可能甚至低于 20%，尤其是在高收入国家。我们的研究结果表明，应该更仔细地评估不正确使用避孕套和避孕套破裂的原因，而不仅仅是故意错误报告，并在资源匮乏的环境中更频繁地采用更私密的数据收集方法，如音频、计算机辅助自我访谈（ACASI），以进一步减少这些环境中的差异。此外，应该使用正确的计算方法对已发表的研究中避孕套使用的自我报告和生物标志物之间的差异进行进一步分析，以更确定这些发现。
