1 reported that 11.4% of 88 Nigerian HIV-infected individuals met the diagnostic criteria for GAD using the MINI. For example, using the MINI international neuropsychiatric interview (MINI), 13.3% of 649 HIV-infected individuals in Zambia met the diagnostic criteria for GAD. The prevalence of GAD among people living with HIV varies widely, depending on the methods of assessment used, that is, structured diagnostic interviews and self-report measures. 9 Over-identification of GAD can lead to an added financial burden on the healthcare system in resource-constrained communities, as false positive cases may be unnecessarily referred for treatment. The major disadvantage of screening, however, is the possibility of yielding large numbers of false positive and false negative cases. Screening instruments, compared to structured interviews, are short, easy to use and require minimal training for test administrators. 7, 8 A screening instrument with poor specificity will positively identify a large number of individuals who do not meet the diagnostic criteria for the disorder, yielding many false positives. Specificity, on the other hand, refers to the ability of the screening instrument to accurately detect individuals without the disorder. 7, 8 A screening instrument with poor sensitivity will miss a large number of individuals who meet the diagnostic criteria for the disorder, yielding a large number of false negative results. 7, 8 Sensitivity refers to the ability of the screening instrument to accurately detect individuals with the disorder. The ability of screening instruments to discriminate between GAD cases and non-cases is usually assessed in terms of the optimal combination of sensitivity and specificity. Successful case identification will enhance the likelihood of persons who need treatment. We sought to evaluate the effectiveness of the Beck anxiety inventory (BAI) in detecting GAD among people seeking HIV testing. 6 Therefore, screening may be necessary to identify individuals with GAD in these environments. Moreover, there are insufficient healthcare professionals in the public health systems in resource-constrained countries such as South Africa who possess the necessary knowledge and skills required to diagnose GAD. 4, 5 Yet, using diagnostic interviews to identify cases of mental disorders, including GAD, is often cost and resource intensive. 1, 2, 3 GAD is highly impairing and is associated with poor quality of life and low levels of adherence to HIV treatment. Generalised anxiety disorder (GAD) is common among people living with HIV (PLWH). Keywords: generalised anxiety disorder sensitivity specificity receiver operating curve analysis HIV Western Cape South Africa. Within resource-constrained communities in South Africa, referral trajectories should be integrated with routine screening and HIV testing Thus, in a public health setting, persons screening positive on the BAI should receive a diagnostic interview to determine whether they are true cases for GAD. A two-tiered method may be useful to mitigate against case over-identification. The positive predictive value was 13%, while the negative predictive value was 99%ĬONCLUSION: Our data suggest that while the BAI may be used to screen for GAD, it is likely to yield a high number of false positives. ![]() Using an optimal cut-off point of 21.5, the sensitivity and specificity of the BAI were 82% and 80%, respectively. RESULTS: 3.4% of the sample met the DSM-5 criteria for a diagnosis of GAD. We used receiver operating curve analysis to determine the optimal cut-off point on the BAI to discriminate between GAD caseness and non-caseness METHOD: We recruited 500 persons seeking HIV testing from five non-medical testing sites in the Western Cape, South Africa. SETTING: Five HIV testing sites in the Western Cape region of South Africa Saal Ashraf Kagee Jason Bantjesĭepartment of Psychology, Arts and Social Sciences, Stellenbosch University, Cape Town, South AfricaīACKGROUND: Routine anxiety screening is needed among HIV test seekers, given the lack of health-care professionals with the ability to identify individuals with generalised anxietyĪIM: The aim of this study was to determine the effectiveness of the Beck anxiety inventory (BAI) in predicting caseness for generalised anxiety disorder (GAD) among persons seeking HIV testing, using the structured clinical interview for the DSM-5 (SCID-5) as the gold standard Evaluation of the Beck Anxiety Inventory in predicting generalised anxiety disorder among individuals seeking HIV testing in the Western Cape province, South Africa
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