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

项目摘要 每年都有大量财政和人力资源投入应对艾滋病毒流行病 国际吧减少艾滋病毒/艾滋病死亡人数是衡量这些艾滋病毒预防和 治疗方案。因此，收集关于艾滋病毒/艾滋病死亡率的尽可能最好的数据以1）监测 （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严重的国家，特别是撒哈拉以南非洲国家， 良好运作的民事登记和疾病监测系统。相反，关于造成 目前，撒哈拉以南非洲的死亡率仅适用于小规模和高度选择的人群。我们建议解决这个问题 通过评估收集艾滋病毒死亡率信息的可行性， 家庭调查，如人口与健康调查。这些数据构成了 国际组织用于估计CRS有限的撒哈拉以南非洲国家全因死亡率的输入。 他们通过要求随机抽样的受访者报告出生日期和（可能） 他们的每一个近亲的死亡（例如，兄弟姐妹）。它们还经常包括对其他 （b）目前没有收集关于艾滋病毒的数据 mortality.因此，我们将改进DHS使用的成人死亡率问卷，增加3-5个直接问题， i）艾滋病毒状况，ii）参与艾滋病毒护理和治疗的每一个报告死亡的亲属。我们将 通过参与性的定性研究进程，编制这一改进的调查表（目标1）。我们将 然后在一项回顾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 对照马拉维卫生和人口监测系统提供的艾滋病毒死亡率参考数据（目标2 及3）。一项嵌套随机子研究也将确定使用音频计算机辅助自我检查是否有效。 艾滋病毒/艾滋病死亡率调查（ACASI）有助于进一步改进死亡率调查中艾滋病毒死亡的报告。如果准确， 这一改进的调查表将直接估计艾滋病毒感染者面临的超额死亡率 在一个国家。这将大大加强对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理解。

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.