Journal Article

Creating and Validating an Algorithm to Measure AIDS Mortality in the Adult Population using Verbal Autopsy

Boerma, J. Ties, Garnett, Geoff P, Harrop, Tara, Lopman, Ben A, Donnelly, Christl A, Nyamukapa, Constance, Gaitskell, Kezia, Gregson, Simon, Barnabas, Ruanne V, Chawira, Godwin, Mason, Peter

2006

Overview

Vital registration and cause of death reporting is incomplete in the countries in which the HIV epidemic is most severe. A reliable tool that is independent of HIV status is needed for measuring the frequency of AIDS deaths and ultimately the impact of antiretroviral therapy on mortality. A verbal autopsy questionnaire was administered to caregivers of 381 adults of known HIV status who died between 1998 and 2003 in Manicaland, eastern Zimbabwe. Individuals who were HIV positive and did not die in an accident or during childbirth (74%; n = 282) were considered to have died of AIDS in the gold standard. Verbal autopsies were randomly allocated to a training dataset (n = 279) to generate classification criteria or a test dataset (n = 102) to verify criteria. A rule-based algorithm created to minimise false positives had a specificity of 66% and a sensitivity of 76%. Eight predictors (weight loss, wasting, jaundice, herpes zoster, presence of abscesses or sores, oral candidiasis, acute respiratory tract infections, and vaginal tumours) were included in the algorithm. In the test dataset of verbal autopsies, 69% of deaths were correctly classified as AIDS/non-AIDS, and it was not necessary to invoke a differential diagnosis of tuberculosis. Presence of any one of these criteria gave a post-test probability of AIDS death of 0.84. Analysis of verbal autopsy data in this rural Zimbabwean population revealed a distinct pattern of signs and symptoms associated with AIDS mortality. Using these signs and symptoms, demographic surveillance data on AIDS deaths may allow for the estimation of AIDS mortality and even HIV prevalence.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Abscesses / Acquired immune deficiency syndrome / Adolescent / Adult / Adults / AIDS / AIDS patients / Algorithms / Autopsies / Autopsy / Caregivers / Cause of Death / Datasets / Diseases / Drug therapy / Epidemiology / Epidemiology/Public Health / Fatalities / Female / General Medicine / Herpes viruses / HIV / HIV Infection/AIDS / HIV Infections - diagnosis / HIV Infections - mortality / HIV/AIDS / Human immunodeficiency virus / Humans / Infections / Infectious Diseases / Interviews as Topic - methods / Male / Measurement / Medicine in Developing Countries / Mortality / Population / Public Health / Qualitative research / Registration / Rural areas / Seroepidemiologic Studies / Sexual Health / Statistics / Surveillance / Surveys and Questionnaires / Trends / Tumors / Vagina / Zimbabwe / Zimbabwe - epidemiology