Abstract
Background: Biological testing for Sexually Transmitted Infections (STI) are challenged by sample collection and high testing costs, where self-reports are used in predicting STI status. The validity of self-reports among populations at STI risk has not been established clearly. The objective of this paper is to assess the validity of selfreported ‘STI symptoms’, self-reported ‘recent condom non- use’ and ‘inconsistent condom use’ in comparison with laboratory diagnosed STIs among men who have sex with men (MSM) in India. Methods: Data were drawn from a cross sectional Integrated Behavioural and Biological Assessment survey conducted among MSM between 2005-2007 in India. Sensitivity analysis was used to assess the validity of selfreported ‘STI symptoms’, ‘recent condom non-use’ and ‘inconsistent condom use’ with laboratory diagnosed STIs (syphilis/Neisseria gonorrhoeae/ Chlamydia trachomatis). Multiple logistic regressions were used to identify population characteristics which were predictive of concordant self-reporting. Results: Of 3895 MSM surveyed, 14.3% were diagnosed with any STI while 8.3% and 3% reported any STI symptom in past and current respectively. Recent condom non-use and inconsistent condom use was reported by 43.1% and 77.6% of respondents. Self-reported STI symptoms showed very low sensitivity (5-13) in predicting laboratory diagnosis of STIs. Self-reported inconsistent condom use and recent condom non-use showed higher sensitivity than self-reported STI symptoms (50-74.4), but were less specific (21-52.9). Combined self reports showed relatively higher sensitivity (52.3-77.9) and low specificity (18.9 -51.8). Overall self reports showed very high negative predictive value (84.4-87.9) and low positive predictive value (12.4-15.7). Education grade more than 12 [AOR: 3.2 (CI 1.7-5.9)], and STI/HIV information exposure [AOR: 1.4 (CI 1.0-2.0)] were predictive of concordant self-reporting of STI symptoms and inconsistent condom use respectively. Knowledge about STIs [AOR: 1.4 (CI 0.9-2.2)] and education grade more than12 [AOR: 2.5 (CI 1.2-5.3)] were predictive of concordant self-reporting of symptoms/risk. Conclusions: Self-reports of STI symptoms, recent condom non-use and inconsistent condom use were not reliable in predicting true STI status of MSM and thus highlights the limitations in the validity of self-reports collected at different levels in the program setting. The study identified MSM education status, STI/HIV knowledge and information exposure, as predictors of concordant self-reporting of ‘symptoms’ and ‘inconsistent condom use’ with STI laboratory diagnosis, which could be utilized in future survey efforts for improving validity of self-reports.
Highlights
Biological testing for Sexually Transmitted Infections (STI) are challenged by sample collection and high testing costs, where self-reports are used in predicting STI status
While a few studies have documented discordance between self-reported STI symptoms and the serological status of men who have sex with men (MSM), a study conducted among Indian MSM, has noted concordance between their self-reported risk behaviors and serological reports of STI’s [25,26,27]. In light of this background of data highlighting both concordance and discordance of ‘self-reports’ with laboratory diagnosis of STI in different populations, our study explores the relationship between selfreported STI symptoms and risk behaviours with laboratory diagnosed STI among MSM, using a dataset from the Integrated Bio Behavioral Assessment Surveys among MSM conducted in three high prevalence states in India
If the desirable sample size was not achieved in a time location clusters (TLC), another new TLC was selected for achieving that sample, and no TLC was selected for the second time
Summary
Biological testing for Sexually Transmitted Infections (STI) are challenged by sample collection and high testing costs, where self-reports are used in predicting STI status. The validity of self-reports among populations at STI risk has not been established clearly. The objective of this paper is to assess the validity of selfreported ‘STI symptoms’, self-reported ‘recent condom non- use’ and ‘inconsistent condom use’ in comparison with laboratory diagnosed STIs among men who have sex with men (MSM) in India. Integrated bio-behavioural surveys (IBBS) have been recommended for estimating the prevalence of HIV/ sexually transmitted infection(STI) and identifying risk factors of HIV/STI [1]. There is still a considerable dependence on populationbased behavioural surveys which primarily utilise self-reported STI symptoms and sexual risk behaviours to estimate STI prevalence. A few studies conducted among female sex workers in India and China and among adult general populations in other settings have noted that reported STI symptoms were inconsistent with the lab diagnosis [1114]
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