The relationships between cognitive function, literacy and HIV status knowledge among older adults in rural South Africa
Year: 2020
Type: article
Abstract: INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
DOI: 10.1002/jia2.25457
Institutions: Indiana University Bloomington, Indiana University, University of the Witwatersrand, Agincourt Health and Socio-Demographic Surveillance System, Indepth Network, Umeå University, Harvard University, Australian National University, Heidelberg University, University Hospital Heidelberg, Africa Health Research Institute, Heidelberg Institute of Global Health, University of Michigan
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,400
Funders: World Bank Group, Alexander von Humboldt-Stiftung, Wellcome Trust, European Commission, South African Medical Research Council, National Institutes of Health, National Institute on Aging, National Institute of Allergy and Infectious Diseases, Fogarty International Center, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Health, population and social transitions in rural Southern Africa: Elucidating pathways and testing interventions., Preventing cardiometabolic diseases in Africa: life-course and multi-sector approaches., Investigating and responding to health, population and social transitions in rural Southern Africa., Causal Pathways to population health impact of HIV antiretroviral treatment, New Methods for the design and evaluation of large HIV prevention interventions, G8186070293, Can HIV Hot-Spots be eradicated? An intervention to decrease HIV transmission to young women in rural KwaZulu-Natal South Africa, Health, Aging and Dementia in South Africa: A Longitudinal Study (HAALSI), HIS : Training Tanzanian Researchers for HIV/AIDS Implementation Science (Renewal)
OpenAlex ID: W3012614641