Verbal autopsy can consistently measure AIDS mortality: a validation study in Tanzania and Zimbabwe

Abstract

BackgroundVerbal autopsy is currently the only option for obtaining cause of death information in most populations with a widespread HIV/AIDS epidemic.MethodsWith the use of a data-driven algorithm, a set of criteria for classifying AIDS mortality was trained. Data from two longitudinal community studies in Tanzania and Zimbabwe were used, both of which have collected information on the HIV status of the population over a prolonged period and maintained a demographic surveillance system that collects information on cause of death through verbal autopsy. The algorithm was then tested in different times (two phases of the Zimbabwe study) and different places (Tanzania and Zimbabwe).ResultsThe trained algorithm, including nine signs and symptoms, performed consistently based on sensitivity and specificity on verbal autopsy data for deaths in 15–44-year-olds from Zimbabwe phase I (sensitivity 79%; specificity 79%), phase II (sensitivity 83%; specificity 75%) and Tanzania (sensitivity 75%; specificity 74%) studies. The sensitivity dropped markedly for classifying deaths in 45–59-year-olds.ConclusionsVerbal autopsy can consistently measure AIDS mortality with a set of nine criteria. Surveillance should focus on deaths that occur in the 15–44-year age group for which the method performs reliably. Addition of a handful of questions related to opportunistic infections would enable other widely used verbal autopsy tools to apply this validated method in areas for which HIV testing and hospital records are unavailable or incomplete.

Pathology of HIV/AIDS: Lessons from Autopsy Series

“…Instead of that new methods are established to assess mortality statistics in developing countries (Bhattacharaya & Neogi, 2008). Currently, the popularity of studies evaluating AIDS-related mortality by means of verbal autopsy is increasing (Bundhamcharoen et al, 2011;Lopman et al, 2010;Negin et al, 2010). We believe that autopsy series represent most reliable sources in estimation of mortality trends.…”

Depression, Delinquency and Peer Problems Among Children and Adolescents Affected by HIV/AIDS in Ghana: The Mediating Role of Child Labour

“…To identify whether children lost one or both parents from AIDS, a verbal autopsy (VA) was used [35]. The present study used the verbal autopsy method to assess the cause of parental death because of the difficulty of obtaining accurate death certificates and because caregivers were often unaware of or did not wish to disclose the parental cause of death.…”

“…The World Health Organisation and Health Metrics Network have approved it for use in developing countries and asserted that it is an essential means of ascertaining AIDS deaths in the absence of HIV/AIDS sero-status record of deceased persons [41]. Lopman and colleagues state clearly the value of verbal autopsy: it is the only option to identify cause of death in widespread HIV/AIDS epidemic settings [35,41].…”

Social Support Disparities among Children affected by HIV/AIDS in Ghana

“…Lopman and colleagues state clearly the value of verbal autopsy: it is the only option to identify cause of death in widespread HIV/AIDS epidemic settings [39,41].…”

“…To identify whether children lost one or both parents from AIDS, a verbal autopsy (VA) was used [39]. The present study used the verbal autopsy method to assess the cause of parental death because of the difficulty of obtaining accurate death certificates and because caregivers were often unaware of or did not wish to disclose the parental cause of death.…”