MRC/UVRI Uganda Research Unit on AIDS, P,O,Box 49, Entebbe, Uganda.
Popul Health Metr. 2011 Aug 4;9:36. doi: 10.1186/1478-7954-9-36.
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.
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.
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.
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.
在生命登记系统不完善的地区，死因包括艾滋病毒的死因推断（即“死因推断”）非常重要。在引入抗逆转录病毒疗法（ART）之前，乌干达农村地区的一项死因推断研究发现，评估的一半成人死亡者都是艾滋病毒阳性个体。我们使用死因推断方法比较了 ART 引入前后成人艾滋病毒阳性死亡者的比例。
在一项前瞻性基于人群的队列研究中，于 2006 年至 2008 年期间，通过每月死亡登记确定所有成人（≥13 岁）死亡者，并通过年度血清学调查确定艾滋病毒血清状况。由一名临床医生使用死因推断调查问卷对死者的一名亲属进行访谈。两名临床医生独立审查问卷，并将死亡分类为艾滋病毒阳性或非阳性。如果意见不一致，第三名临床医生作为仲裁人。使用艾滋病毒血清状况作为比较的金标准来评估死因推断工具的性能。我们比较了 20 世纪 90 年代初和 2006-2008 年期间死因推断评估的艾滋病毒阳性死亡比例。
在已知艾滋病毒血清状况的 12641 名成人中，有 333 人死亡，其中 264 人（79.3%）接受了死因推断评估，其中 59 人（22.3%）艾滋病毒血清阳性，68 人（25.8%）被死因推断为艾滋病毒阳性。死因推断识别艾滋病毒感染者死亡的特异性为 90.2%，阳性预测值为 70.6%，观察者间一致性较高（80.3%；kappa 统计量=0.69）。死因推断估计的艾滋病毒病死率从 ART 前时期的 47.0%下降到 ART 时期的 25.8%，p<0.001。
在资源有限的环境中，死因推断可以很好地估计成人死亡中艾滋病毒感染的流行率。在这个农村人群中，20 世纪 90 年代初和 2006-2008 年期间，死因推断确定的艾滋病毒阳性死亡比例有所下降。死因推断结果可为艾滋病毒保健需求的政策提供信息。
