Collecting data on HIV-related mortality during household surveys: a randomized validation study in Malawi

BackgroundIn many African countries, there are limited representative data on HIV/AIDS mortality. We tested whether such data could be collected during household surveys periodically conducted in most African countries. MethodsWe added HIV questions to the module on adult and maternal mortality used in Demographic and Health Surveys. We conducted a validation study of the data generated by these questions in northern Malawi. We randomly assigned men and women aged 15-59 years old to a face-to-face interview or audio computer-assisted self-interviewing (ACASI). We compared survey reports of adult deaths to prospective data on mortality and HIV collected by the Karonga Health and Demographic Surveillance Site. We calculated the sensitivity and specificity of survey data in recording the HIV status of deceased siblings of respondents. We adjusted for partial verification bias using multiple imputations. ResultsWe interviewed 535 participants, who reported 885 deaths at ages 15 and older. The added HIV questions yielded largely complete data on the HIV status of respondents deceased siblings, particularly those who died recently. The adjusted sensitivity of survey data on HIV status of the deceased was high in both study groups (0.78-0.82). There were few false positive reports of the HIV status of deceased siblings (specificity = 0.96-0.98). ACASI did not improve the accuracy of survey data, but it required more time to collect mortality reports. Asking the HIV questions only took 0.4 minute ({approx}25 seconds) per deceased sibling in face-to-face interviews. ConclusionsAdding HIV questions to mortality questionnaires used in household surveys yields accurate data on the HIV status of deceased adults. These new data could aid in tracking progress towards global HIV elimination targets. MEIRU - LSHTM - JHU Partnership for improving adult mortality data1,2