Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008

Verbal autopsy is important for detecting causes of death including HIV in areas with inadequate vital registration systems. This paper uses verbal autopsy to compare the proportion of HIV-positive adult deaths in rural Uganda in the periods before and after antiretroviral therapy (ART) introduction.

The paper indicates that before ART introduction, an assessment found that half of adult deaths were in HIV-positive individuals. Yet, during the time of the study, the estimated national ART coverage in Uganda was 33 per cent.

The paper finds that:

• verbal autopsy has an overall specificity of 90 per cent, and positive predictive value of 71 per cent in identifying HIV infection among adult deaths
• verbal autopsy performs well in identifying HIV-positive deaths in the age groups 13 to 44 years and 45 to 64 years
• the positive predictive value of verbal autopsy is lower among people aged 65 and older than in the younger age groups because of the lower prevalence of HIV-positive deaths
• comparing with the period before ART was introduced, there is a decline in the proportion of HIV-positive deaths.
  

Conclusions include:

• in resource-limited settings, verbal autopsy can provide a good estimate of the prevalence of HIV infection among adult deaths
• policymakers should consider verbal autopsy as a source of information about deaths occurring among HIV-positive individuals and HIV-associated deaths
• this important source can be added in routine health information systems
• in populations with a lower prevalence of HIV-positive deaths among people over 65, improved verbal autopsy tools are needed to reliably measure HIV-positive deaths in this age group.