Feasibility of measuring HIV-related mortality during population-based surveys in Africa

项目摘要 每年都投入大量的财力和人力资源来应对艾滋病毒流行。 全世界。减少艾滋病毒/艾滋病死亡人数是这些艾滋病毒预防和治疗工作取得成功的最明显指标之一 治疗方案。因此，收集尽可能好的艾滋病毒/艾滋病死亡率数据以进行监测是至关重要的 实现这一目标的进展和2)评估艾滋病毒方案的影响。不幸的是，绝大多数 受艾滋病毒流行影响最大的国家，特别是位于撒哈拉以南非洲的国家，往往缺乏 运作良好的民事登记和疾病监测系统(CRS)。相反，关于致病原因的可靠数据 SSA中的死亡目前只适用于少数和高度精选的人群。我们建议解决这个问题 缺乏代表性数据，评估在#年收集艾滋病毒死亡率信息的可行性 家庭调查，如人口和健康调查(DHS)。这些数据构成了主要的 国际组织用于估计CRS有限的SSA国家全因死亡率的投入。 他们通过要求随机抽样的受访者报告出生日期和(可能的)死亡率来衡量死亡率 他们的每一个近亲(例如，兄弟姐妹)死亡。它们还经常包括对其他 孕产妇死亡和意外事故等死因，但目前没有收集关于艾滋病毒的数据 死亡率。因此，我们将改进国土安全部使用的成人死亡率问卷，提出3-5个直接问题 一)艾滋病毒状况和二)每个报告的已故亲属参与艾滋病毒护理和治疗的情况。我们会 通过质量研究的参与性进程(目标1)编制这份改进后的问卷。我们会 然后在一项回溯性验证研究中测量该问卷在记录艾滋病毒死亡方面的准确性 对照马拉维健康和人口监测系统中艾滋病毒死亡率的参考数据(目标2 &3)。一项嵌套的随机化子研究也将确定使用计算机辅助音频是否会 访谈(ACASI)有助于进一步改进在死亡率调查期间报告艾滋病毒死亡的情况。如果准确的话， 这份改进后的问卷将直接估计艾滋病毒携带者面临的超额死亡率。 在一个国家。这有望显著加强对#年艾滋病毒护理和治疗方案的评估。 SSA，并提高我们对艾滋病毒护理级联的了解。

PROJECT ABSTRACT Every year, large amounts of financial and human resources are invested in addressing HIV epidemics worldwide. Reducing HIV/AIDS deaths is one of the clearest indicators of success in these HIV prevention and treatment programs. It is thus crucial to collect the best possible data on HIV/AIDS mortality to 1) monitor progress towards this target and 2) evaluate the impact of HIV programs. Unfortunately, the vast majority of countries most affected by HIV epidemics, in particular those located in Sub-Saharan Africa (SSA), often lack well-functioning civil registration and disease surveillance systems (CRS). Instead, reliable data on causes of death in SSA are currently only available for small and highly selected populations. We propose to address this lack of representative data by assessing the feasibility of collecting information on HIV mortality during household surveys such as the Demographic and Health Surveys (DHS). These data constitute the primary input used by international organizations to estimate all-cause mortality in SSA countries with limited CRS. They measure mortality by asking a random sample of respondents to report the date of birth and (possibly) death of each of their close relatives (e.g., siblings). They frequently also include an assessment of other causes of death such as maternal mortality and accidents, but they do not currently collect data on HIV mortality. We will thus enhance the adult mortality questionnaire used by the DHS with 3-5 direct questions on i) the HIV status and ii) the engagement in HIV care and treatment of each reported deceased relative. We will develop this enhanced questionnaire through a participatory process of qualitative research (aim 1). We will then measure the accuracy of this questionnaire in recording HIV deaths during a retrospective validation study against reference data on HIV mortality from a health and demographic surveillance system in Malawi (aims 2 & 3). A nested randomized sub-study will also determine whether the use of audio computer-assisted self- interviewing (ACASI) can help further improve the reporting of HIV deaths during mortality surveys. If accurate, this enhanced questionnaire will yield direct estimates of the excess mortality faced by persons living with HIV in a country. This promises to significantly strengthen the evaluation of HIV care and treatment programs in SSA, and to improve our understanding of the HIV care cascade.