Karikalan Nagarajan, Sheela Godbole, Lakshmi Ramakrishnan, Mandar K. Mainkar, Sowmya Ramesh, Deepika Ganju and Ramesh S Paranjape
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.
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