Maraba Noriah, Karat Aaron S, McCarthy Kerrigan, Churchyard Gavin J, Charalambous Salome, Kahn Kathleen, Grant Alison D, Chihota Violet
The Aurum Institute, Parktown, Johannesburg, South Africa
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Trans R Soc Trop Med Hyg. 2016 Sep;110(9):510-516. doi: 10.1093/trstmh/trw058. Epub 2016 Oct 7.
Adults being investigated for TB in South Africa experience high mortality, yet causes of death (CoD) are not well defined. We determined CoD in this population using verbal autopsy (VA), and compared HIV- and TB-associated CoD using physician-certified verbal autopsy (PCVA) and InterVA-4 software.
All contactable consenting caregivers of participants who died during a trial comparing Xpert MTB/RIF to smear microscopy were interviewed using the WHO VA tool. CoD were assigned using PCVA and InterVA-4. Kappa statistic (K) and concordance correlation coefficient (CCC) were calculated for comparison.
Among 231 deaths, relatives of 137 deceased were interviewed. Of the 137 deceased 76 (55.4%) were males, median age 41 years (IQR 33-50). PCVA assigned 70 (51.1%) TB immediate CoD (44 [62.8%] pulmonary TB; 26 [37.1%] extra-pulmonary TB); 21 (15.3%) HIV/AIDS-related; and 46 (33.5%) other CoD. InterVA-4 assigned 48 (35.0%) TB deaths; 49 (35.7%) HIV/AIDS-related deaths; and 40 (29.1%) other CoD. Agreement between PCVA and InterVA-4 CoD was slight at individual level (K=0.20; 95% CI 0.10-0.30) and poor at population level (CCC 0.67; 95% CI 0.38-0.99).
TB and HIV are leading CoD among adults being investigated for TB. PCVA and InterVA agreement at individual level was slight and poor at population level. VA methodology needs further development where TB and HIV are common.
在南非，接受结核病调查的成年人死亡率很高，但死亡原因尚不明确。我们使用口头尸检（VA）确定了该人群的死亡原因，并使用医生认证的口头尸检（PCVA）和InterVA-4软件比较了与艾滋病毒和结核病相关的死亡原因。
使用世界卫生组织的VA工具，对在一项比较Xpert MTB/RIF与涂片显微镜检查的试验中死亡的参与者的所有可联系且同意参与的照顾者进行了访谈。使用PCVA和InterVA-4确定死亡原因。计算kappa统计量（K）和一致性相关系数（CCC）进行比较。
在231例死亡病例中，对137例死者的亲属进行了访谈。在这137例死者中，76例（55.4%）为男性，中位年龄41岁（四分位间距33 - 50岁）。PCVA确定70例（51.1%）为结核病直接死亡原因（44例[62.8%]为肺结核；26例[37.1%]为肺外结核）；21例（15.3%）与艾滋病毒/艾滋病相关；46例（33.5%）为其他死亡原因。InterVA-4确定48例（35.0%）为结核病死亡；49例（35.7%）为艾滋病毒/艾滋病相关死亡；40例（29.1%）为其他死亡原因。PCVA和InterVA-4确定的死亡原因在个体水平上一致性一般（K = 0.20；95%置信区间0.10 - 0.30），在总体水平上一致性较差（CCC 0.67；95%置信区间0.38 - 0.99）。
结核病和艾滋病毒是接受结核病调查的成年人的主要死亡原因。PCVA和InterVA在个体水平上一致性一般，在总体水平上较差。在结核病和艾滋病毒常见的地区，VA方法需要进一步改进。
