By Jim Todd, Emma Slaymaker, Mary Mahy, Peter Byass, Basia Zaba
For the past 30 years, many communities and countries in sub-Saharan Africa have suffered from the ravages of the HIV epidemic. During this time the mortality rates in HIV-infected people have been 10–20 times higher than in HIV-uninfected people. Since the advent of anti-retroviral therapy (ART), mortality and morbidity have decreased considerably. However, it has been difficult to get reliable estimates of the impact of ART in population-based studies. The measurement of the impact of ART on mortality requires long-term follow-up in communities where regular HIV testing allows the estimation of mortality by HIV status, such as the population cohorts in the network for Analysing Longitudinal Population-based HIV data in Africa (ALPHA). An alternative estimation from verbal autopsy (VA) requires reliable tools and consistent interpretation of causes of death, which have been taken forward by recent standards from the World Health Organization (WHO) and the development of the corresponding InterVA-4 model for cause of death assignment.
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