title: Comprehensive knowledge of HIV among women in rural Mozambique: development and validation of the HIV knowledge 27 scale.
abstract: BACKGROUND
  The relationship between HIV knowledge and HIV-related behaviors in settings like Mozambique has been limited by a lack of rigorously validated measures.
  
  
  METHODS
  A convenience sample of women seeking prenatal care at two clinics were administered an adapted, orally-administered, 27 item HIV-knowledge scale, the HK-27. Validation analyses were stratified by survey language (Portuguese and Echuabo). Kuder-Richardson (KR-20) coefficients estimated internal reliability. Construct validity was assessed with bivariate associations between HK-27 scores (% correct) and selected participant characteristics. The association between knowledge, self-reported HIV testing, and HIV infection were evaluated with multivariable logistic regression.
  
  
  RESULTS
  Participants (N = 348) had a median age of 24; 188 spoke Portuguese, and 160 spoke Echuabo. Mean HK-27 scores were higher for Portuguese-speaking participants than Echuabo-speaking participants (68% correct vs. 42%, p<0.001). Internal reliability was strong (KR-20>0.8) for scales in both languages. Higher HK-27 scores were significantly (p≤0.05) correlated with more education, more media items in the home, a history of HIV testing, and participant work outside of the home for women of both languages. HK-27 scores were independently associated with completion of HIV testing in multivariable analysis (per 1% correct: aOR:1.02, 95%CI:0.01-0.03, p = 0.01), but not with HIV infection.
  
  
  CONCLUSIONS
  HK-27 is a reliable and valid measure of HIV knowledge among Portuguese and Echuabo-speaking Mozambican women. The HK-27 demonstrated significant knowledge deficits among women in the study, and higher scores were associated with higher HIV testing probability. Future studies should evaluate the role of the HK-27 in longitudinal studies and in other populations.
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America. Philip.Ciampa@vanderbilt.edu
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Ciampa
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Skinner
authors.forename: Sérgio R
authors.initials: SR
authors.lastname: Patricio
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Audet
mesh_terms: D000328:Adult; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission* / Q000821:virology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007802:Language; D016015:Logistic Models; D009073:Mozambique; D015999:Multivariate Analysis; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult