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

Lopman B, Cook A, Smith J, Chawira G, Urassa M, Kumogola Y, Isingo R, Ihekweazu C, Ruwende J, Ndege M, Gregson S, Zaba B, Boerma TJ.

In Press, Bul . WHO

Background:  HIV/AIDS is the leading cause of death among young adults in virtually all countries with generalized epidemics but hospital records and vital registration of are inadequate for estimating the level of AIDS mortality in most affected countries. Verbal autopsy (VA) procedures are currently the only option for obtaining cause of death information in these populations.
Methods:  Two longitudinal community studies in Tanzania and Zimbabwe provide a unique opportunity to investigate and further develop the most sensitive and specific set of VA questions to ascertain HIV/AIDS- associated mortality. Both studies have collected information on the HIV status of the population over a prolonged period of time and maintain a demographic surveillance system that collects information on cause of death through verbal autopsy. Using serological data from the Manicaland study, an algorithm was previously developed to determine the most useful questions for categorising AIDS deaths. Here, we test that algorithm in a different time (later round of the Manicaland study) and a different place (Kisesa Ward, Tanzania). 
Results:  Through slight modification to the algorithm, we found verbal autopsy can consistently measure AIDS mortality with a set of nine criteria.  Analyses should be restricted to age groups where competing causes of mortality, especially infectious causes, are low. 
Conclusions:  We recommend that surveillance focus on deaths that occur in the 15 to 44 year age group.  Addition of a handful of questions related to opportunistic infections would enable other widely used verbal autopsy tool to apply this validated methodology in areas where HIV testing and hospital records are unavailable or incomplete.

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