Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008
<p>Abstract</p> <p>Background</p> <p>Verbal autopsy is important for detecting causes of death including HIV in areas with inadequate vital registration systems. Before antiretroviral therapy (ART) introduction, a verbal autopsy study in rural Uganda found that half of...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2011-08-01
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| Series: | Population Health Metrics |
| Online Access: | http://www.pophealthmetrics.com/content/9/1/36 |
| _version_ | 1818212313826590720 |
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| author | Mugisha Joseph O Kibengo Freddie M Nalweyiso Norah Baisley Kathy Mayanja Billy N Van der Paal Lieve Maher Dermot Kaleebu Pontiano |
| author_facet | Mugisha Joseph O Kibengo Freddie M Nalweyiso Norah Baisley Kathy Mayanja Billy N Van der Paal Lieve Maher Dermot Kaleebu Pontiano |
| author_sort | Mugisha Joseph O |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Verbal autopsy is important for detecting causes of death including HIV in areas with inadequate vital registration systems. Before antiretroviral therapy (ART) introduction, a verbal autopsy study in rural Uganda found that half of adult deaths assessed were in HIV-positive individuals. We used verbal autopsy to compare the proportion of HIV-positive adult deaths in the periods before and after ART introduction.</p> <p>Methods</p> <p>Between 2006 and 2008, all adult (≥ 13 years) deaths in a prospective population-based cohort study were identified by monthly death registration, and HIV serostatus was determined through annual serosurveys. A clinical officer interviewed a relative of the deceased using a verbal autopsy questionnaire. Two clinicians independently reviewed the questionnaires and classified the deaths as HIV-positive or not. A third clinician was the tie-breaker in case of nonagreement. The performance of the verbal autopsy tool was assessed using HIV serostatus as the gold standard of comparison. We compared the proportions of HIV-positive deaths as assessed by verbal autopsy in the early 1990s and the 2006-2008 periods.</p> <p>Results</p> <p>Of 333 deaths among 12,641 adults of known HIV serostatus, 264 (79.3%) were assessed by verbal autopsy, of whom 59 (22.3%) were HIV-seropositive and 68 (25.8%) were classified as HIV-positive by verbal autopsy. Verbal autopsy had a specificity of 90.2% and positive predictive value of 70.6% for identifying deaths among HIV-infected individuals, with substantial interobserver agreement (80.3%; kappa statistic = 0.69). The HIV-attributable mortality fraction estimated by verbal autopsy decreased from 47.0% (pre-ART period) to 25.8% (ART period), p < 0.001.</p> <p>Conclusions</p> <p>In resource-limited settings, verbal autopsy can provide a good estimate of the prevalence of HIV infection among adult deaths. In this rural population, the proportion of deaths identified by verbal autopsy as HIV-positive declined between the early 1990s and the 2006-2008 period. Verbal autopsy findings can inform policy on HIV health care needs.</p> |
| first_indexed | 2024-12-12T05:46:25Z |
| format | Article |
| id | doaj.art-b78877b431734215b52c6a1f20556cc4 |
| institution | Directory Open Access Journal |
| issn | 1478-7954 |
| language | English |
| last_indexed | 2024-12-12T05:46:25Z |
| publishDate | 2011-08-01 |
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| series | Population Health Metrics |
| spelling | doaj.art-b78877b431734215b52c6a1f20556cc42022-12-22T00:35:48ZengBMCPopulation Health Metrics1478-79542011-08-01913610.1186/1478-7954-9-36Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008Mugisha Joseph OKibengo Freddie MNalweyiso NorahBaisley KathyMayanja Billy NVan der Paal LieveMaher DermotKaleebu Pontiano<p>Abstract</p> <p>Background</p> <p>Verbal autopsy is important for detecting causes of death including HIV in areas with inadequate vital registration systems. Before antiretroviral therapy (ART) introduction, a verbal autopsy study in rural Uganda found that half of adult deaths assessed were in HIV-positive individuals. We used verbal autopsy to compare the proportion of HIV-positive adult deaths in the periods before and after ART introduction.</p> <p>Methods</p> <p>Between 2006 and 2008, all adult (≥ 13 years) deaths in a prospective population-based cohort study were identified by monthly death registration, and HIV serostatus was determined through annual serosurveys. A clinical officer interviewed a relative of the deceased using a verbal autopsy questionnaire. Two clinicians independently reviewed the questionnaires and classified the deaths as HIV-positive or not. A third clinician was the tie-breaker in case of nonagreement. The performance of the verbal autopsy tool was assessed using HIV serostatus as the gold standard of comparison. We compared the proportions of HIV-positive deaths as assessed by verbal autopsy in the early 1990s and the 2006-2008 periods.</p> <p>Results</p> <p>Of 333 deaths among 12,641 adults of known HIV serostatus, 264 (79.3%) were assessed by verbal autopsy, of whom 59 (22.3%) were HIV-seropositive and 68 (25.8%) were classified as HIV-positive by verbal autopsy. Verbal autopsy had a specificity of 90.2% and positive predictive value of 70.6% for identifying deaths among HIV-infected individuals, with substantial interobserver agreement (80.3%; kappa statistic = 0.69). The HIV-attributable mortality fraction estimated by verbal autopsy decreased from 47.0% (pre-ART period) to 25.8% (ART period), p < 0.001.</p> <p>Conclusions</p> <p>In resource-limited settings, verbal autopsy can provide a good estimate of the prevalence of HIV infection among adult deaths. In this rural population, the proportion of deaths identified by verbal autopsy as HIV-positive declined between the early 1990s and the 2006-2008 period. Verbal autopsy findings can inform policy on HIV health care needs.</p>http://www.pophealthmetrics.com/content/9/1/36 |
| spellingShingle | Mugisha Joseph O Kibengo Freddie M Nalweyiso Norah Baisley Kathy Mayanja Billy N Van der Paal Lieve Maher Dermot Kaleebu Pontiano Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008 Population Health Metrics |
| title | Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008 |
| title_full | Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008 |
| title_fullStr | Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008 |
| title_full_unstemmed | Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008 |
| title_short | Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008 |
| title_sort | using verbal autopsy to assess the prevalence of hiv infection among deaths in the art period in rural uganda a prospective cohort study 2006 2008 |
| url | http://www.pophealthmetrics.com/content/9/1/36 |
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