VERBAL AUTOPSY AS A TOOL FOR DIAGNOSING HIV-RELATED ADULT DEATHS IN RURAL UGANDA

Background. In general, information on the causes of adult deaths in d eveloping countries is scarce. More specifically, relatively little is known about the effect of HIV-1 associated disease on adult mortality in general populations. In this study we have used a verbal autopsy t echnique to ascertain whether adult deaths were associated with HIV-1 in a rural population with a prevalence of HIV-1 infection of 8%, and used HIV-1 antibody status to validate the verbal autopsy findings. Me thods. All adult deaths in the population cohort that occurred between December 1990 and November 1993 were identified through a monthly dea th registration system. Approximately 2 months after death, a relative of the deceased was interviewed by a trained nurse, and questionnaire s were assessed by at least two independent clinicians; all were unawa re of the HIV serostatus of the deceased. Results. A total of 155 adul t deaths was assessed, i.e. 53% of all recorded adult deaths. Of those assessed half were HIV-1 positive. In all 47% of deaths were classifi ed as HIV-related. The overall specificity and positive predictive val ue of the verbal autopsy tool were both 92%; in those aged 13-44 years (83 adults) the corresponding values were 85% and 95% respectively. T he verbal autopsy estimated HIV-1 attributable mortality fraction was similar to the calculated fraction based on prospective data. Conclusi ons. The results of this study suggest that verbal autopsy studies may assist in providing data on HIV-associated mortality in general popul ations and may be useful as surveillance tools.