Accuracy of Physicians in Diagnosing HIV and AIDS-Related Death in the Adult Population of Addis Ababa, Ethiopia

Abstract

Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur at home. Objective: To evaluate the accuracy of physician reviewers of verbal autopsies in diagnosing HIV and AIDS-related deaths in the adult population of Addis Ababa, the capital of Ethiopia. Methods: This study was done within the context of a burial surveillance system in Addis Ababa. Trained interviewers completed a standard verbal autopsy questionnaire and an independent panel of physicians reviewed the completed form to assign cause of death. Physicians' review was compared to a reference standard constructed based on prospectively collected HIV-serostatus and patients' hospital record. Sensitivity and specificity were calculated to validate the physicians' verbal autopsy diagnoses against reference standards. Results: Physicians accurately identified AIDS-related deaths with sensitivity and specificity of 0.88 (95% CI: 0.80 - 0.93) and 0.77 (95% CI: 0.64 - 0.87), respectively. Generally, there was high level of agreement (Cohen's Kappa Statistic (K > 0.6) between the first two physicians with some yearly variations. In 2008 and 2009 there was an almost perfect agreement (K > 0.80). Conclusion: This study demonstrated the agreement level between two independent physicians in diagnosing AIDS-related death is very high and thus using a single verbal autopsy coder is practical for programmatic purposes in countries where there is critical shortage of doctors

HIV mortality in urban slums of Nairobi, Kenya 2003–2010: a period effect analysis

“…The specificity of VA in diagnosing non-HIV deaths among those who were HIV negative was 81 percent (29 non-HIV deaths out of 36 HIV negative persons). These findings are consistent with previous studies which have shown that verbal autopsies are considerably valid in detecting HIV deaths especially among adults though underestimation of HIV deaths is not uncommon [43-45]. Generally, the accuracy of verbal autopsies interpreted by physicians is said to have an acceptable level of diagnostic accuracy, at the population level, if sensitivity and specificity are at least 50 percent and 90 percent respectively [46].…”

Causes of Death among Adults in Northern Ethiopia: Evidence from Verbal Autopsy Data in Health and Demographic Surveillance System

“…In countries where registration of vital events is incomplete(inaccurate) and the proportion of people who die at home without medical care is high, verbal autopsy (VA) is used to identify causes of death [3] , [4] , [5] , [7] , [8] , [9] and measure patterns of causes of death [10] . Several studies showed that VA can be used to generate reasonable population level estimates of causes of death [11] , [12] . Thus, the VA method is recommended to obtain a population level estimate of causes of deaths in the absence of a medical recording system [4] , [13] .…”

InterVA versus Spectrum: how comparable are they in estimating AIDS mortality patterns in Nairobi's informal settlements?

“…The AIDS Impact Module (AIM) within Spectrum was used for this analysis (version 4.50). The software is described in detail elsewhere (39). Here, we provide a brief description of how the software works and how it was adjusted to create a Nairobi-specific model.…”