Can children recognise HIV-associated symptoms in their carers? Evaluation of a verbal assessment tool for children in South Africa.

Measuring child awareness for adult symptomatic HIV using a verbal assessment tool: concordance between adult-child dyads on adult HIV-associated symptoms and illnesses.

Becker E, Kuo C, Operario D, Moshabela M, Cluver L. Sex Transm Infect. 2015 Nov;91(7):528-33. doi: 10.1136/sextrans-2014-051728. Epub 2015 Jan 13.

Objectives: This study assessed children's awareness for adult HIV-associated symptoms and illnesses using a verbal assessment tool by analysing inter-rater reliability between adult-child dyads. This study also evaluated sociodemographic and household characteristics associated with child awareness of adult symptomatic HIV.

Methods: A cross-sectional survey using a representative community sample of adult-child dyads (N=2477 dyads) was conducted in KwaZulu-Natal, South Africa. Analyses focused on a subsample (n=673 adult-child dyads) who completed verbal assessment interviews for symptomatic HIV. We used an existing validated verbal autopsy approach, originally designed to determine AIDS-related deaths by adult proxy reporters. We adapted this approach for use by child proxy reporters for reporting on HIV-associated symptoms and illnesses among living adults. Analyses assessed whether children could reliably report on adult HIV-associated symptoms and illnesses and adult provisional HIV status.

Results: Adult-child pairs concurred above the 65th percentile for 9 of the 10 HIV-associated symptoms and illnesses with sensitivities ranging from 10% to 100% and specificities ranging from 20% to 100%. Concordant reporting between adult-child dyads for the adult's provisional HIV status was 72% (sensitivity=68%, specificity=73%). Children were more likely to reliably match adult's reports of provisional HIV status when they lived in households with more household members, and households with more robust socioeconomic indicators including access to potable water, food security and television.

Conclusions: Children demonstrate awareness of HIV-associated symptoms and illnesses experienced by adults in their household. Children in households with greater socioeconomic resources and more household members were more likely to reliably report on the adult's provisional HIV status.

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Editor’s notes: This study tested a new tool for assessing whether children who are caring for adults living with HIV in their household are able to recognise HIV-associated symptoms and illnesses. The study was conducted with households in one rural and one urban site in KwaZulu-Natal, South Africa. The authors report on the analysis of results from a sub-sample of 673 dyads, composed of one adult and one child living in the same household. With the help of researchers, children aged 10-17, completed a verbal tool that was adapted for this study from a previous ‘verbal autopsy’ tool used to assess AIDS-associated deaths. The adult in each of the dyads also completed an adult version of the study’s adapted tool. The tool contained questions on ten symptoms and illnesses associated with HIV. Some of these strongly indicate HIV presence when found in a combination of two or more (e.g. TB; oral candidiasis; diarrhoea; herpes). Children-adult responses were compared in each dyad and tested for concurrency and sensibility. Overall, children and adult responses matched for more than 65% for nine out of ten of the symptoms/illnesses listed. There were variations in reliable matching depending on symptoms/illnesses. Some symptoms may have been harder for children to report on behalf of the adult, for example, constant diarrhoea. The tool used with the children may be useful for improving our understanding of the issues faced by young carers in households where some members are living with HIV. The tool may also help to understand strategies put in place by young carers looking after an adult with HIV-associated illnesses.

South Africa
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