Julia K. Rohr, F. Xavier Gómez-Olivé, Molly Rosenberg, Jennifer Manne-Goehler, Pascal Geldsetzer, Ryan Wagner, Brain Houle, Joshua A. Salomon, Kathleen Kahn, Stephen Tollman, Lisa Berkman, and Till Bärnighausen. 2017. “Performance of self-reported HIV status in determining true HIV status among older adults in rural South Africa: a validation study.” Journal of the International AIDS Society 20 (1). Publisher's VersionAbstract
Introduction : In South Africa, older adults make up a growing proportion of people living with HIV. HIV programmes are likely to reach older South Africans in home-based interventions where testing is not always feasible. We evaluate the accuracy of self-reported HIV status, which may provide useful information for targeting interventions or offer an alternative to biomarker testing. Methods : Data were taken from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) baseline survey, which was conducted in rural Mpumalanga province, South Africa. A total of 5059 participants aged ≥40 years were interviewed from 2014 to 2015. Self-reported HIV status and dried bloodspots for HIV biomarker testing were obtained during at-home interviews. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for self-reported status compared to “gold standard” biomarker results. Log-binomial regression explored associations between demographic characteristics, antiretroviral therapy (ART) status and sensitivity of self-report. Results : Most participants (93%) consented to biomarker testing. Of those with biomarker results, 50.9% reported knowing their HIV status and accurately reported it. PPV of self-report was 94.1% (95% confidence interval (CI): 92.0–96.0), NPV was 87.2% (95% CI: 86.2–88.2), sensitivity was 51.2% (95% CI: 48.2–54.3) and specificity was 99.0% (95% CI: 98.7–99.4). Participants on ART were more likely to report their HIV-positive status, and participants reporting false-negatives were more likely to have older HIV tests. Conclusions : The majority of participants were willing to share their HIV status. False-negative reports were largely explained by lack of testing, suggesting HIV stigma is retreating in this setting, and that expansion of HIV testing and retesting is still needed in this population. In HIV interventions where testing is not possible, self-reported status should be considered as a routine first step to establish HIV status. Keywords  Validation study; South Africa; HIV status; self-report; older adults; public health To access the supplementary material to this article please see  Supplementary Files  under Article Tools online. (Published: 18 July 2017) Rohr J et al.  Journal of the International AIDS Society  2017,  20 :21691  |
Collin F Payne, Francesc Xavier Gómez-Olivé, Kathleen Kahn, and Lisa Berkman. 2017. “Physical Function in an Aging Population in Rural South Africa: Findings From HAALSI and Cross-National Comparisons With HRS Sister Studies.” J Gerontol B Psychol Sci Soc Sci, 72, 4, Pp. 665-679.Abstract
Objectives: We use recently-collected data from the Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) cohort from Agincourt, South Africa, to describe physical functioning in this aging population, and place the overall level and age-trajectories of physical health in the context of other Health and Retirement Study (HRS) sister studies in low- and middle-income countries (LMICs). Method: We conduct multiple regression to estimate associations of physical functioning assessed from both self-report (activities of daily living [ADL] limitation, self-reported health) and performance (grip strength, gait speed) with socio-demographic and health characteristics in HAALSI, and use fully-interacted regression models to compare age-patterns of physical functioning outcomes cross-nationally. Results: Gender differences in self-reported health are minimal, and men had 30% higher odds of being ADL limited controlling for socio-demographic and health characteristics. Measured physical performance is closely tied with socioeconomic conditions, but self-reported measures have a much smaller or weaker socioeconomic gradient. In international age-adjusted comparisons, the HAALSI sample had lower physical performance outcomes than most comparison populations. Discussion: As the first HRS sister study undertaken in Africa, HAALSI adds vital information on population aging and health in the region. Continuing waves of HAALSI data will be a key resource for understanding differences in the complex processes of disability across LMIC contexts.
Molly S. Rosenberg, F. Xavier Gómez-Olivé, Julia K. Rohr, Brian C. Houle, Chodziwadziwa W. Kabudula, Ryan G. Wagner, Joshua A. Salomon, Kathleen Kahn, Lisa F. Berkman, Stephen M. Tollman, and Till W. Bärnighausen. 9/17/2016. “Sexual behaviors and HIV status: a population-based study among older adults in rural South Africa.” JAIDS Journal of Acquired Immune Deficiency Syndromes, Publish Ahead of Print. Publisher's VersionAbstract

Objective: To identify whether older adults in rural South Africa have unmet needs for HIV prevention.Methods: We analyzed data from a population-based sample of 5059 men and women aged 40 and older from Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities (HAALSI) undertaken in the Agincourt sub-district of Mpumalanga Province, underpinned by the Agincourt health and socio-demographic surveillance system. We estimated the prevalence of HIV (laboratory-confirmed and self-reported) and key sexual behaviors by age and sex. We compared sexual behavior profiles across HIV status categories with and without age-sex-standardization.

Glyn W. Humphreys, Mihaela D. Duta, Livia Montana, Nele Demeyere, Cathal McCrory, Julia Rohr, Kathleen Kahn, Stephen Tollman, and Lisa Berkman. 2016. “Cognitive Function in Low-Income and Low-Literacy Settings: Validation of the Tablet-Based Oxford Cognitive Screen in the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI).” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. Publisher's VersionAbstract
Objectives: 1. Assess validity of the Oxford Cognitive Screen (OCS-Plus), a domain-specific cognitive assessment designed for low-literacy settings, especially in low- and middle-income countries (LMIC); 2. Advance theoretical contributions in cognitive neuroscience in domain-specific cognitive function and cognitive reserve, especially related to dementia.Method: In a cross-sectional study of a sample of 1,402 men and women aged 40–79 in the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we administered OCS-Plus along with health and sociodemographic assessments. HAALSI is a representative sample of older adults in Agincourt, South Africa contributing to normative understanding of cognition in LMIC. We report measure distributions, construct and external validity of the OCS-Plus.Results: OCS-Plus has excellent construct and external validity. Intra-class correlations between similar basic measures of orientation in OCS-Plus and in HAALSI assessments was 0.79, and groups of people performing well on the OCS-Plus verbal memory also showed superior performance on HAALSI verbal memory. The OCS-Plus scores showed consistent associations with age and education and domain-specific associations with alcohol and depression. Younger respondents and the more educated did better on all assessments.Discussion: The OCS-Plus represents a major methodological advance in dementia studies in LMICs, and enhances understanding of cognitive aging.
Stephen M Tollman, Shane A Norris, and Lisa F Berkman. 2016. “Commentary: The value of life course epidemiology in low- and middle-income countries: an ageing perspective.” International Journal of Epidemiology, 45, 4, Pp. 997-999. Publisher's Version
Jennifer Manne-Goehler, Livia Montana, Xavier Gomez-Olive, Julia Rohr, Ryan Wagner, Chodziwadziwa Kabudula, Alisha Wade, Kathleen Kahn, Stephen Tollman, Lisa Berkman, Till Barnighausen, and Thomas Gaziano. 2016. “Human Immunodeficiency Virus (HIV) Infection, Antiretroviral Therapy (ART) Use and Access to Care for Diabetes and Hypertension in Agincourt, South Africa.” Open Forum Infectious Diseases, 3. Publisher's Version
Xavier F Gómez-Olivé, Margaret Thorogood, Philippe Bocquier, Paul Mee, Kathleen Kahn, Lisa Berkman, and Stephen Tollman. 2014. “Social conditions and disability related to the mortality of older people in rural South Africa.” International Journal of Epidemiology, 43, 5, Pp. 1531-1541. Publisher's VersionAbstract
Background: South Africa is experiencing a health and social transition including an ageing population and an HIV epidemic. We report mortality experience of an older rural South African population.Methods: Individual survey data and longer-term demographic data were used to describe factors associated with mortality. Individuals aged 50 years and over (n = 4085) answered a health and quality of life questionnaire in 2006 and were followed for 3 years thereafter. Additional vital events and socio-demographic data were extracted from the Agincourt Health and Demographic Surveillance System from 1993 to 2010, to provide longer-term trends in mortality. Cox regression analysis was used to determine factors related to survival.Results: In 10 967 person-years of follow-up between August 2006 and August 2009, 377 deaths occurred. Women had lower mortality {hazard ratio [HR] 0.35 [95% confidence interval (CI) 0.28–0.45]}. Higher mortality was associated with being single [HR 1.48 (95% CI 1.16–1.88)], having lower household assets score [HR 1.79 (95% CI 1.28–2.51)], reporting greater disability [HR 2.40 (95% CI 1.68–3.42)] and poorer quality of life [HR 1.59 (95% CI 1.09–2.31)]. There was higher mortality in those aged under 69 as compared with those 70 to 79 years old. Census data and cause specific regression models confirmed that this was due to deaths from HIV/TB in the younger age group.Conclusions: Mortality due to HIV/TB is increasing in men, and to some extent women, aged over 50. Policy makers and practitioners should consider the needs of this growing and often overlooked group.