InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries
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Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
Global Health Action
Abstract
Reliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are
scanty, even though that is the region where most of the world’s AIDS deaths occur. There is therefore a great
need for reliable and valid public health tools for assessing AIDS mortality.
Objective: The aim of this article is to validate the InterVA-4 verbal autopsy (VA) interpretative model within
African populations where HIV sero-status is recorded on a prospective basis, and examine the distribution of
cause-specific mortality among HIV-positive and HIV-negative people.
Design: Data from six sites of the Alpha Network, including HIV sero-status and VA interviews, were pooled.
VA data according to the 2012 WHO format were extracted, and processed using the InterVA-4 model into
likely causes of death. The model was blinded to the sero-status data. Cases with known pre-mortem HIV
infection status were used to determine the specificity with which InterVA-4 could attribute HIV/AIDS as a
cause of death. Cause-specific mortality fractions by HIV infection status were calculated, and a person-time
model was built to analyse adjusted cause-specific mortality rate ratios.
Results: The InterVA-4 model identified HIV/AIDS-related deaths with a specificity of 90.1% (95% CI
88.7 91.4%). Overall sensitivity could not be calculated, because HIV-positive people die from a range of
causes. In a person-time model including 1,739 deaths in 1,161,688 HIV-negative person-years observed and
2,890 deaths in 75,110 HIV-positive person-years observed, the mortality ratio HIV-positive:negative was
29.0 (95% CI 27.1 31.0), after adjustment for age, sex, and study site. Cause-specific HIV-positive:negative
mortality ratios for acute respiratory infections, HIV/AIDS-related deaths, meningitis, tuberculosis, and
malnutrition were higher than the all-cause ratio; all causes had HIV-positive:negative mortality ratios
significantly higher than unity.
Description
Keywords
HIV/AIDS, mortality, Africa, verbal autopsy, InterVA, Alpha Network
Citation
Peter Byass, Clara Calvert, Jessica Miiro-Nakiyingi, Tom Lutalo, Denna Michael, Amelia Crampin, Simon Gregson, Albert Takaruza, Laura Robertson, Kobus Herbst, Jim Todd & Basia Zaba (2013) InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries, Global Health Action, 6:1, 22448, DOI: 10.3402/ gha.v6i0.22448