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Verbal autopsy can consistently measure AIDS mortality: a validation study in Tanzania and Zimbabwe
  1. B Lopman1,
  2. A Cook2,
  3. J Smith1,
  4. G Chawira3,
  5. M Urassa2,
  6. Y Kumogola2,
  7. R Isingo2,
  8. C Ihekweazu4,
  9. J Ruwende4,
  10. M Ndege2,
  11. S Gregson1,3,
  12. B Zaba2,5,
  13. T Boerma6
  1. 1Department of Infectious Disease Epidemiology, Imperial College, London, UK
  2. 2National Institute for Medical Research, Mwanza, Tanzania
  3. 3Biomedical Research and Training Institute, Harare, Zimbabwe
  4. 4Health Protection Agency, London, UK
  5. 5Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, UK
  6. 6World Health Organization, Geneva, Switzerland
  1. Correspondence to Ben Lopman, Imperial College, London, UK; blopman{at}


Background Verbal autopsy is currently the only option for obtaining cause of death information in most populations with a widespread HIV/AIDS epidemic.

Methods With the use of a data-driven algorithm, a set of criteria for classifying AIDS mortality was trained. Data from two longitudinal community studies in Tanzania and Zimbabwe were used, both of which have collected information on the HIV status of the population over a prolonged period and maintained a demographic surveillance system that collects information on cause of death through verbal autopsy. The algorithm was then tested in different times (two phases of the Zimbabwe study) and different places (Tanzania and Zimbabwe).

Results The trained algorithm, including nine signs and symptoms, performed consistently based on sensitivity and specificity on verbal autopsy data for deaths in 15–44-year-olds from Zimbabwe phase I (sensitivity 79%; specificity 79%), phase II (sensitivity 83%; specificity 75%) and Tanzania (sensitivity 75%; specificity 74%) studies. The sensitivity dropped markedly for classifying deaths in 45–59-year-olds.

Conclusions Verbal autopsy can consistently measure AIDS mortality with a set of nine criteria. Surveillance should focus on deaths that occur in the 15–44-year age group for which the method performs reliably. Addition of a handful of questions related to opportunistic infections would enable other widely used verbal autopsy tools to apply this validated method in areas for which HIV testing and hospital records are unavailable or incomplete.

  • Death certification
  • demography FQ
  • HIV epidemiology
  • HIV infection
  • mortality SI
  • mortality
  • sub-Saharan Africa
  • verbal autopsy

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  • Funding The comparative study presented here was funded by WHO Health Metrics Network. The Manicaland Study is principally funded by the Wellcome Trust, and the Kisesa study is currently funded by the Global Fund for AIDS, TB and Malaria and by the Wellcome Trust; prior to 2004, it was mainly funded by the Netherlands government through the TANESA programme. Other Funders: Wellcome Trust.

  • Competing interests None.

  • Ethics approval Ethical approval for the DSS and all related procedures (such as the verbal autopsy interviews) was granted by the Tanzanian Medical Research Co-ordinating Committee for the Kisesa study and by the Zimbabwe Medical Research Council for the Manicaland Study.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.