Disclosure of HSV-2 Serological Test Results in the Context of an Adolescent HIV Prevention Trial in Kenya

Citation

Hallfors, Denise Dion; Cho, Hyunsan; Mbai, Isabella; Millimo, Benson W.; Atieno, Carolyne; Okumu, David; Luseno, Winnie Kavulani; Hartman, Shane; Halpern, Carolyn Tucker; & Hobbs, Marcia M. (2015). Disclosure of HSV-2 Serological Test Results in the Context of an Adolescent HIV Prevention Trial in Kenya. Sexually Transmitted Infections, 91(6), 395-400. PMCID: PMC4546528

Abstract

Objectives: Herpes simplex virus type 2 (HSV-2) biomarkers are often used in adolescent sub-Saharan HIV prevention studies, but evaluations of test performance and disclosure outcomes are rare in the published literature. Therefore, we investigated the proportion of ELISA-positive and indeterminate samples confirmed by western blot (WB), the psychosocial response to disclosure and whether reports of sexual behaviour and HSV-2 symptoms are consistent with WB confirmatory results among adolescent orphans in Kenya.
Methods: In 2011, 837 Kenyan orphan youth in grades 7 and 8 enrolled in an HIV prevention clinical trial with HSV-2 biomarker outcomes. We used a modified algorithm for the Kalon HSV-2 ELISA to improve specificity; positive and indeterminate results were WB tested. We developed culturally sensitive protocols for disclosing positive results, and documented psychosocial responses, reports of sexual contact and HSV-2 symptoms.
Results: 28 adolescents (3.3%) were identified as HSV-2 seropositive, six as indeterminate. Of these, 22 positive and all indeterminates were WB tested; 20 and 5, respectively, were confirmed positive. Most youth reported moderate brief stress after disclosure; 22% reported longer and more severe distress. Boys were more likely to be in the latter category. Self-reported virginity was highly inconsistent with WB-confirmed positives.
Conclusions The higher than manufacturer's cut-off for Kalon ELISA modestly reduced the rate of falsepositive test results, but also increased false negatives. Investigators should consider the risk: benefit ratio in deciding whether or not to disclose HSV-2 results to adolescent participants under specific field conditions.

URL

http://dx.doi.org/10.1136/sextrans-2015-052025

Reference Type

Journal Article

Year Published

2015

Journal Title

Sexually Transmitted Infections

Author(s)

Hallfors, Denise Dion
Cho, Hyunsan
Mbai, Isabella
Millimo, Benson W.
Atieno, Carolyne
Okumu, David
Luseno, Winnie Kavulani
Hartman, Shane
Halpern, Carolyn Tucker
Hobbs, Marcia M.

PMCID

PMC4546528

ORCiD

Halpern - 0000-0003-4278-5646