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dc.rights.licenseCreative Commons Attribution License
dc.contributor.authorKarat, Aaron S.en
dc.contributor.authorTlali, Mphoen
dc.contributor.authorFielding, Katherine L.en
dc.contributor.authorCharalambous, Salomeen
dc.contributor.authorChihota, Violet N.en
dc.contributor.authorChurchyard, Gavin J.en
dc.contributor.authorHanifa, Yasmeenen
dc.contributor.authorJohnson, Suzanneen
dc.contributor.authorMcCarthy, Kerriganen
dc.contributor.authorMartinson, Neil A.en
dc.contributor.authorOmar, Tanvieren
dc.contributor.authorKahn, Kathleenen
dc.contributor.authorChandramohan, Danielen
dc.contributor.authorGrant, Alison D.en
dc.contributor.editorIsaakidis, Petrosen
dc.identifier.citationKarat, A. S., Tlali, M., Fielding, K. L., Charalambous, S., Chihota, V. N., Churchyard, G. J., Hanifa, Y., Johnson, S., McCarthy, K., Martinson, N. A., Omar, T., Kahn, K., Chandramohan, D. & Grant, A. D. (2017) Measuring mortality due to HIV-associated tuberculosis among adults in South Africa: Comparing verbal autopsy, minimally-invasive autopsy, and research data. PLOS One, 12(3).en
dc.descriptionAaron S. Karat - ORCID 0000-0001-9643-664X
dc.description.abstractBackground The World Health Organization (WHO) aims to reduce tuberculosis (TB) deaths by 95% by 2035; tracking progress requires accurate measurement of TB mortality. International Classification of Diseases (ICD) codes do not differentiate between HIV-associated TB and HIV more generally. Verbal autopsy (VA) is used to estimate cause of death (CoD) patterns but has mostly been validated against a suboptimal gold standard for HIV and TB. This study, conducted among HIV-positive adults, aimed to estimate the accuracy of VA in ascertaining TB and HIV CoD when compared to a reference standard derived from a variety of clinical sources including, in some, minimally-invasive autopsy (MIA).en
dc.description.abstractMethods and findings Decedents were enrolled into a trial of empirical TB treatment or a cohort exploring diagnostic algorithms for TB in South Africa. The WHO 2012 instrument was used; VA CoD were assigned using physician-certified VA (PCVA), InterVA-4, and SmartVA-Analyze. Reference CoD were assigned using MIA, research, and health facility data, as available. 259 VAs were completed: 147 (57%) decedents were female; median age was 39 (interquartile range [IQR] 33±47) years and CD4 count 51 (IQR 22±102) cells/μL. Compared to reference CoD that included MIA (n = 34), VA underestimated mortality due to HIV/AIDS (94% reference, 74% PCVA, 47% InterVA-4, and 41% SmartVA-Analyze; chance-corrected concordance [CCC] 0.71, 0.42, and 0.31, respectively) and HIV-associated TB (41% reference, 32% PCVA; CCC 0.23). For individual decedents, all VA methods agreed poorly with reference CoD that did not include MIA (n = 259; overall CCC 0.14, 0.06, and 0.15 for PCVA, InterVA-4, and SmartVA-Analyze); agreement was better at population level (cause-specific mortality fraction accuracy 0.78, 0.61, and 0.57, for the three methods, respectively).
dc.description.abstractConclusions Current VA methods underestimate mortality due to HIV-associated TB. ICD and VA methods need modifications that allow for more specific evaluation of HIV-related deaths and direct estimation of mortality due to HIV-associated TB.
dc.description.sponsorshipThis study was funded by a grant from the Bill & Melinda Gates Foundation (OPP1083118; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.en
dc.relation.ispartofPLOS Oneen
dc.rights© 2017 Karat et al.
dc.titleMeasuring mortality due to HIV-associated tuberculosis among adults in South Africa: Comparing verbal autopsy, minimally-invasive autopsy, and research dataen
rioxxterms.typeJournal Article/Reviewen
qmu.authorKarat, Aaron S.en
qmu.centreInstitute for Global Health and Developmenten

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