Creating and validating an algorithm to measure AIDS mortality in the adult population using verbal autopsy
Creating and validating an algorithm to measure AIDS mortality in the adult population using verbal autopsy
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DOI：
10.1371/journal.pmed.0030312
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发表时间：
2006-08-01
期刊：
影响因子：
15.8
通讯作者：
Gregson, Simon
中科院分区：
文献类型：
--
作者：
Lopman, Ben A.;Barnabas, Ruanne V.;Gregson, Simon
背景在艾滋病毒流行最严重的国家，生命登记和死因报告不完整。需要一种独立于艾滋病毒状况的可靠工具来衡量艾滋病死亡的频率，并最终衡量抗逆转录病毒治疗对死亡率的影响。方法和结果对1998年至2003年在津巴布韦东部马尼卡兰死亡的381名已知艾滋病毒状况的成年人的照顾者进行了口头尸检问卷调查。按照金标准，艾滋病毒阳性且未死于意外事故或分娩过程的人(74%；n=282)被认为死于艾滋病。口头尸检被随机分配到训练数据集(n=279)以生成分类标准或测试数据集(N 102)以验证标准。为尽量减少假阳性而创建的基于规则的算法具有66%的特异度和76%的灵敏度。八项预测指标(体重减轻、消瘦、黄疸、带状疱疹、是否有脓肿或溃疡、口腔念珠菌病、急性呼吸道感染和阴道肿瘤)被纳入该算法。在口头尸检的测试数据集中，69%的死亡被正确归类为艾滋病/非艾滋病，没有必要援引结核病的鉴别诊断。这些标准中的任何一项的存在都给出了艾滋病死亡的测试后概率为0.84。结论对津巴布韦农村人口的口头尸检数据分析揭示了与艾滋病死亡相关的明显的体征和症状模式。利用这些迹象和症状，艾滋病死亡的人口监测数据可以估计艾滋病死亡率，甚至艾滋病毒流行率。
Background Vital registration and cause of death reporting is incomplete in the countries in which the HIV epidemic is most severe. A reliable tool that is independent of HIV status is needed for measuring the frequency of AIDS deaths and ultimately the impact of antiretroviral therapy on mortality.Methods and Findings A verbal autopsy questionnaire was administered to caregivers of 381 adults of known HIV status who died between 1998 and 2003 in Manicaland, eastern Zimbabwe. Individuals who were HIV positive and did not die in an accident or during childbirth (74%; n = 282) were considered to have died of AIDS in the gold standard. Verbal autopsies were randomly allocated to a training dataset (n = 279) to generate classification criteria or a test dataset ( n 102) to verify criteria. A rule-based algorithm created to minimise false positives had a specificity of 66% and a sensitivity of 76%. Eight predictors (weight loss, wasting, jaundice, herpes zoster, presence of abscesses or sores, oral candidiasis, acute respiratory tract infections, and vaginal tumours) were included in the algorithm. In the test dataset of verbal autopsies, 69% of deaths were correctly classified as AIDS/non-AIDS, and it was not necessary to invoke a differential diagnosis of tuberculosis. Presence of any one of these criteria gave a post-test probability of AIDS death of 0.84.Conclusions Analysis of verbal autopsy data in this rural Zimbabwean population revealed a distinct pattern of signs and symptoms associated with AIDS mortality. Using these signs and symptoms, demographic surveillance data on AIDS deaths may allow for the estimation of AIDS mortality and even HIV prevalence.