Reliability of reporting of HIV status and antiretroviral therapy usage during verbal autopsies: a large prospective study in rural Malawi

Figures & data

Table 1 Characteristics of deceased according to whether respondents reported HIV status^a

		HIV status known		Univariate chi-square	Multivariable logistic regression^b (n=1,952)
	Total	n	%	p	OR	p
Total	1,952	1,560	79.9
Sex				0.012
Male	947	779	82.3		1
Female	1,005	781	77.7		0.7	0.011
Age group (years)				<0.001
15–19	69	57	82.6		1
20–29	213	144	67.6		0.5	0.066
30–44	503	358	71.2		0.6	0.23
45–59	342	269	78.7		0.9	0.766
60–74	369	309	83.7		1.3	0.471
75+	456	423	92.8		3.1	0.004
Year of death				<0.001	1.3	<0.001
2003–2004	300	144	48.0
2005–2006	386	312	80.8
2007–2008	344	240	69.8
2009–2010	317	273	86.1
2011–2012	302	292	96.7
2013–2014	303	299	98.7
Place of death				0.043	N/A
Home	705	583	82.7
Health facility	1,012	801	79.2
Traditional healer	23	15	65.2
Relative's house	89	65	73
Other	121	94	77.7
Missing^c	2	2	100
Highest schooling				<0.001	N/A
None	259	217	83.8
1–3 years of primary	394	344	87.3
4–7 years of primary	466	373	80
Primary completed	357	257	72
JCE completed	168	133	79.2
MSCE completed	207	148	71.5
Missing^c	101	88	87.1
Rank of employment				<0.001	N/A
Low	513	434	84.6
Medium	1,170	929	79.4
High	175	115	65.7
Missing^c	96	82	85.4
Type of respondent				<0.001	N/A
Parent	286	212	74.1
Partner/sibling/child	1,138	936	82.2
Other relative	485	386	79.6
Non-relative	43	26	60.5
AIDS symptoms				0.001	N/A
One or fewer	1,293	1,061	82.1
Two or more	650	493	75.8
Missing^c	9	6	66.7
Latest KPS/self-reported HIV result				0.224	N/A
Negative	563	529	94
Positive	279	257	92.1
Unknown	117	105	89.7
Total number of HIV tests reported to KPS				<0.001	1.4	0.001
None	1,156	817	70.7
One to two	479	438	91.4
Three to four	255	244	95.7
Five or more	62	61	98.4
Time between death and interview				0.575	1.01	0.073
Within 6 weeks	1,412	1,119	79.2
6 weeks to 6 months	439	356	81.1
6–12 months	79	66	83.5
Over 12 months	22	19	86.4

KPS, Karonga Prevention Study; OR, Odds ratio; JCE, Junior Certificate of Education (taken after 2 years of secondary school); MSCE, Malawi School Certificate of Education (taken after 4 years of secondary school).

^aWhere data on HIV status were available from verbal autopsy, n=1,952.

^bMultivariable logistic regression model included only variables with a result here; all variables included in model as continuous variables except where OR given for each level.

^cRecords with missing values were excluded from the analysis concerning that variable.

Table 2 Comparing HIV status reported to KPS prior to death with HIV status reported by respondent in the VA^a

		HIV status reported in VA
HIV status reported by deceased to KPS		Negative	Positive	Unknown	Total
Negative	n	515	14	34	563
	(row%)	(91.5%)	(2.5%)	(6%)	(100%)
	(column%)				(58.7%)
Positive	n	25	232	22	279
	(row%)	(9%)	(83.2%)	(7.9%)	(100%)
	(column%)				(29.1%)
Unknown	n	100	5	12	117
	(row%)	(85.5%)	(4.3%)	(10.3%)	(100%)
	(column%)				(12.2%)
Total	n	640	251	68	959
	(row%)	(66.7%)	(26.2%)	(7.1%)	(100%)

KPS, Karonga Prevention Study; VA, verbal autopsy.

^aWhere data on HIV status were available from both VA and other KPS source, n=959.

Table 3 Characteristics of deceased according to whether HIV status reported by respondent agrees with other information known to KPS^a

		VA agree		Univariate chi-square	Multivariable logistic regression^b (n=959)
	Total	n	%	p	OR	p
Total	959	759	79.1
Sex				0.006
Male	485	401	82.7		1
Female	474	358	75.5		1	0.941
Age group (years)				<0.001	1.2	0.047
15–19	30	25	83.3
20–29	100	82	82
30–44	231	199	86.1
45–59	171	140	81.9
60–74	183	142	77.6
75+	244	171	70.1
Year of death				0.002	1	0.937
2003–2004	1	0	0
2005–2006	36	31	86.1
2007–2008	97	64	66
2009–2010	268	208	77.6
2011–2012	279	223	79.9
2013–2014	278	233	83.8
Place of death				0.009	N/A
Home	302	220	72.8
Health facility	542	450	83
Traditional healer	12	8	66.7
Relative's house	40	31	77.5
Other	63	50	79.4
Highest schooling				0.056	N/A
None	127	86	67.7
1–3 years of primary	183	140	76.5
4–7 years of primary	221	174	78.7
Primary completed	180	147	81.7
JCE completed	89	72	80.9
MSCE completed	94	77	81.9
Missing^c	65	63	96.9
Rank of employment				0.041	N/A
Low	227	165	72.7
Medium	607	488	80.4
High	61	45	73.8
Missing^c	64	61	95.3
Type of respondent				<0.001
Parent	129	115	89.1		1
Partner/sibling/child	590	471	79.8		0.3	0.005
Other relative	223	158	70.9		0.3	0.004
Non-relative	17	15	88.2		2.7	0.333
AIDS symptoms				0.068	N/A
One or fewer	663	514	77.5
Two or more	295	244	82.7
Missing^c	1	1	100
Total number of HIV tests reported to KPS				<0.001	1.3	0.005
None	163	58	35.6
One to two	479	404	84.3
Three to four	255	236	92.5
Five or more	62	61	98.4
HIV status reported pre-mortem to KPS				<0.001
Negative	563	515	91.5		0	–
Positive	279	232	83.2		0.6	0.03
Unknown	117	12	10.3		0.02	<0.001
Time between death and interview				0.474
Within 6 weeks	675	531	78.7
6 weeks to 6 months	230	183	79.6
6–12 months	45	39	86.7
Over 12 months	9	6	66.7

^aWhere data on HIV status available both from VA and other KPS source, n=959.

^bMultivariable logistic regression model included only variables with a result here; all variables included in model as continuous variables except where OR given for each level.

^cRecords with missing values were excluded from the analysis concerning that variable.

Table 4 Characteristics of deceased according to whether ART usage reported by respondent agrees with other information known to KPS^a

		VA agree		Univariate^b chi-square	Multivariable logistic regression^c (n=154)
	Total	n	%	p	OR	p
Total	154	129	83.8
Sex				0.212
Male	81	65	80.2		1
Female	73	64	87.7		2.3	0.154
Age group (years)				0.821	1.2	0.604
15–19	4	3	75
20–29	17	14	82.4
30–44	78	64	82.1
45–59	46	39	84.8
60–74	7	7	100
75+	2	2	100
Year of death				0.765	1.1	0.483
2007–2008	4	3	75
2009–2010	56	47	83.9
2011–2012	52	42	80.8
2013–2014	42	37	88.1
AIDS symptoms				0.101	0.1	0.004
One or fewer	66	59	89.4
Two or more	88	70	79.5
Total number of HIV tests reported to KPS				0.035	1.6	0.069
None	12	8	66.7
One to two	82	65	79.3
Three to four	43	39	90.7
Five or more	17	17	100
ART usage reported pre-mortem to KPS				<0.001	31.3	<0.001
Never started ART	28	13	46.4
Started ART	126	116	92.1

^aWhere data on ART usage available both from VA and other KPS source, n=154.

^bUnivariate analysis for the following variables not shown (all p>0.1): place of death, highest schooling, rank of employment, type of respondent, and time between death and VA.

^cMultivariable logistic regression model included only variables with a result here; all variables included in model as continuous variables except where OR given for each level.

Fig. 1 Percentage of deaths coded as HIV/AIDS where no HIV test data available to reviewers (n=1,559), showing influence of report from VA.