Fishel, Joy D., Bernard Barrère, and Sunita Kishor. 2014. Validity of Data on Self-reported HIV Status in Malawi and Uganda and Implications for Measurement of ARV Coverage. DHS Methodological Reports No. 10. Rockville, Maryland, USA: ICF International.
Objective: To assess the validity of self-reported HIV status in two population-based surveys—the 2010 Malawi DHS and the 2011 Uganda AIS—to determine whether self-reported HIV status can be used as a basis for measuring indicators of use of services such as ART and PMTCT by people living with HIV (PLHIV).
Methods: Self-reported HIV status was compared with HIV serostatus obtained from blood test results. Among HIV-positive respondents with HIV-negative self-reports a simulation was conducted using estimates of HIV incidence and time since last HIV test to predict the percentage of respondents likely to have seroconverted since their last test. Finally, the impact of the validity of data on self-reported HIV status on service coverage indicators is assessed.
Results: A total of 40 percent of HIV-positive women and 36 percent of HIV-positive men in Malawi and 32 percent of HIV-positive women and 24 percent of HIV positive men in Uganda reported that they had been tested for HIV, had received the result, and the result was HIV-negative. Among respondents who were HIV-positive on the survey blood test, the percentage likely to have seroconverted since their last HIV test was estimated at 1 percent or lower among women and men in both surveys.
Conclusions: There is evidence of substantial underreporting of positive HIV status among respondents who are likely to know they have HIV. The low validity of data on self-reported HIV status will affect indicators of service use by PLHIV and estimates of eligibility for ART based on CD4 testing.