Altmetric

InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries

Title: InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries
Authors: Byass, P
Calvert, C
Miiro-Nakiyingi, J
Lutalo, T
Michael, D
Crampin, A
Gregson, S
Takaruza, A
Robertson, L
Herbst, K
Todd, J
Zaba, B
Item Type: Journal Article
Abstract: Background: Reliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are scanty, even though that is the region where most of the world’s AIDS deaths occur. There is therefore a great need for reliable and valid public health tools for assessing AIDS mortality. Objective: The aim of this article is to validate the InterVA-4 verbal autopsy (VA) interpretative model within African populations where HIV sero-status is recorded on a prospective basis, and examine the distribution of cause-specific mortality among HIV-positive and HIV-negative people. Design: Data from six sites of the Alpha Network, including HIV sero-status and VA interviews, were pooled. VA data according to the 2012 WHO format were extracted, and processed using the InterVA-4 model into likely causes of death. The model was blinded to the sero-status data. Cases with known pre-mortem HIV infection status were used to determine the specificity with which InterVA-4 could attribute HIV/AIDS as a cause of death. Cause-specific mortality fractions by HIV infection status were calculated, and a person-time model was built to analyse adjusted cause-specific mortality rate ratios. Results: The InterVA-4 model identified HIV/AIDS-related deaths with a specificity of 90.1% (95% CI 88.7–91.4%). Overall sensitivity could not be calculated, because HIV-positive people die from a range of causes. In a person-time model including 1,739 deaths in 1,161,688 HIV-negative person-years observed and 2,890 deaths in 75,110 HIV-positive person-years observed, the mortality ratio HIV-positive:negative was 29.0 (95% CI 27.1–31.0), after adjustment for age, sex, and study site. Cause-specific HIV-positive:negative mortality ratios for acute respiratory infections, HIV/AIDS-related deaths, meningitis, tuberculosis, and malnutrition were higher than the all-cause ratio; all causes had HIV-positive:negative mortality ratios significantly higher than unity. Conclusions: These results were generally consistent with relatively small post-mortem and hospital-based diagnosis studies in the literature. The high specificity in cause of death attribution achieved in relation to HIV status, and large differences between specific causes by HIV status, show that InterVA-4 is an effective and valid tool for assessing HIV-related mortality.
Issue Date: 18-Oct-2013
Date of Acceptance: 27-Sep-2013
URI: http://hdl.handle.net/10044/1/39907
DOI: http://dx.doi.org/10.3402/gha.v6i0.22448
ISSN: 1654-9880
Publisher: Co-Action Publishing
Journal / Book Title: Global Health Action
Volume: 6
Copyright Statement: © 2013 Peter Byass et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported (CC BY 3.0) License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
HIV/AIDS
mortality
Africa
verbal autopsy
InterVA
Alpha Network
Adolescent
Adult
Africa South of the Sahara
Aged
Autopsy
Cause of Death
Female
HIV Infections
Humans
Male
Middle Aged
Public Health
Young Adult
Publication Status: Published
Article Number: 22448
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commonsx