Evaluation of the Beck Anxiety Inventory in predicting generalised anxiety disorder among individuals seeking HIV testing in the Western Cape province, South Africa

BACKGROUND: Routine anxiety screening is needed among HIV test seekers, given the lack of health-care professionals with the ability to identify individuals with generalised anxiety. AIM: 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. SETTING: Five HIV testing sites in the Western Cape region of South Africa. METHOD: We recruited 500 persons seeking HIV testing from five non-medical testing sites in the Western Cape, South Africa. We used receiver operating curve analysis to determine the optimal cut-off point on the BAI to discriminate between GAD caseness and non-caseness. RESULTS: 3.4% of the sample met the DSM-5 criteria for a diagnosis of GAD. Using an optimal cut-off point of 21.5, the sensitivity and specificity of the BAI were 82% and 80%, respectively. The positive predictive value was 13%, while the negative predictive value was 99%. CONCLUSION: 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. A two-tiered method may be useful to mitigate against case over-identification. 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. Within resource-constrained communities in South Africa, referral trajectories should be integrated with routine screening and HIV testing.