Performance of verbal autopsy methods in estimating HIV-associated mortality among adults in South Africa
Performance of verbal autopsy methods in estimating HIV-associated mortality among adults in South Africa
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DOI：
10.1136/bmjgh-2018-000833
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发表时间：
2018-07-01
影响因子：
8.1
通讯作者：
Grant, Alison D.
中科院分区：
文献类型：
--
作者：
Karat, Aaron S.;Maraba, Noriah;Grant, Alison D.
口头解剖（VA）可以整合到民事登记和生命统计系统中，但其在确定艾滋病毒相关死亡原因（CoD）方面的准确性尚不确定。我们评估了VA问题在确定HIV状态和抗逆转录病毒治疗（ART）启动方面的敏感性和特异性，并比较了不同VA解释方法分配的HIV相关死亡率分数。方法使用世卫组织2012年附加ART问题的工具，对南非已知艾滋病毒感染状况的成年人（356例艾滋病毒阳性和103例艾滋病毒阴性）的死亡进行VA。使用医师认证VA （PCVA）和计算机编码VA （CCVA）方法分配CoD，并与记录的HIV状态进行比较。结果VA问题在检测HIV状态和ART启动方面的敏感性分别为84.3% （95% CI 80 ~ 88）和91.0% (95% CI 86 ~ 95)；283/356例hiv阳性个体（79.5%）通过PCVA、166例（46.6%）通过InterVA-4.03、201例（56.5%）通过InterVA-5、80例（22.5%）和289例（81.2%）通过SmartVA-Analyze V.1.1.1和V.1.2.1进行hiv相关CoD鉴定。PCVA和旧CCVA方法之间的一致性很差（机会校正一致性[CCC]）。
Introduction Verbal autopsy (VA) can be integrated into civil registration and vital statistics systems, but its accuracy in determining HIV-associated causes of death (CoD) is uncertain. We assessed the sensitivity and specificity of VA questions in determining HIV status and antiretroviral therapy (ART) initiation and compared HIV-associated mortality fractions assigned by different VA interpretation methods.Methods Using the WHO 2012 instrument with added ART questions, VA was conducted for deaths among adults with known HIV status (356 HIV positive and 103 HIV negative) in South Africa. CoD were assigned using physician-certified VA (PCVA) and computer-coded VA (CCVA) methods and compared with documented HIV status.Results The sensitivity of VA questions in detecting HIV status and ART initiation was 84.3% (95% CI 80 to 88) and 91.0% (95% CI 86 to 95); 283/356 (79.5%) HIV-positive individuals were assigned HIV-associated CoD by PCVA, 166 (46.6%) by InterVA-4.03, 201 (56.5%) by InterVA-5, and 80 (22.5%) and 289 (81.2%) by SmartVA-Analyze V.1.1.1 and V.1.2.1. Agreement between PCVA and older CCVA methods was poor (chance-corrected concordance [CCC]