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Measuring mortality...
Measuring mortality due to HIV-associated tuberculosis among adults in South Africa : Comparing verbal autopsy, minimally-invasive autopsy, and research data
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Karat, Aaron S. (författare)
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Tlali, Mpho (författare)
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Fielding, Katherine L. (författare)
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Charalambous, Salome (författare)
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Chihota, Violet N. (författare)
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Churchyard, Gavin J. (författare)
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Hanifa, Yasmeen (författare)
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Johnson, Suzanne (författare)
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McCarthy, Kerrigan (författare)
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Martinson, Neil A. (författare)
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Omar, Tanvier (författare)
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- Kahn, Kathleen (författare)
- Umeå universitet,Epidemiologi och global hälsa,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana
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Chandramohan, Daniel (författare)
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Grant, Alison D. (författare)
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(creator_code:org_t)
- 2017-03-23
- 2017
- Engelska.
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:3
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https://journals.plo...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Background 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). Methods 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/mu L. 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). Conclusions 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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
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Karat, Aaron S.
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Tlali, Mpho
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Fielding, Kather ...
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Charalambous, Sa ...
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Chihota, Violet ...
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Churchyard, Gavi ...
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visa fler...
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Hanifa, Yasmeen
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Johnson, Suzanne
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McCarthy, Kerrig ...
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Martinson, Neil ...
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Omar, Tanvier
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Kahn, Kathleen
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Chandramohan, Da ...
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Grant, Alison D.
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visa färre...
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