Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS?

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dc.contributor.advisorMyer, Landon
dc.contributor.advisorNannan, Nadine
dc.contributor.advisorBradshaw, Debbie
dc.contributor.authorMaqungo, Monique
dc.date.accessioned2025-10-30T13:19:36Z
dc.date.available2025-10-30T13:19:36Z
dc.date.issued2025
dc.date.updated2025-10-30T12:34:39Z
dc.description.abstractBackground: The South African National Cause-of-Death Validation (2017/18) project utilized the WHO 2016 standard VA questionnaire, which included both structured questions and an open narrative from the next of kin to describe the events surrounding deaths. An unexpected finding was the significant number of HIV/AIDS-related deaths mentioning treatment default in the narrative. Objectives: This study aims to determine the accuracy of VA narratives in identifying ART treatment default by linking data from the national treatment register with NCODV 2017/18 HIV/AIDS related death data. Methods: Secondary analysis of VA data from the NCODV 2017/18 project after linking with TIER.Net data on ART treatment maintained by the Department of Health. Agreement between treatment default identified from VA narratives and from TIER.Net was investigated using Cohen's Kappa (k), and the sensitivity and specificity of the narrative for identifying treatment default was estimated. Results: Data linkage succeeded for 691 (58.9%) deaths, with 62 (5.3%) cases excluded due to inconsistencies. Among the 629 linked cases, 48.3% were identified as treatment defaulters in TIER.Net, compared to 29.4% indicated by VA narratives. The agreement between VA narratives and TIER.Net was 59.1%, with a Cohen's Kappa value of 0.17 (95% CI: 0.10–0.24). Sensitivity and specificity of VA narratives for identifying treatment default were 38.2% (95% CI: 34.4%–42.0%) and 78.8% (95% CI: 75.6%–82.0%) respectively, with positive and negative predictive values of 62.7% (95% CI: 58.9%–66.5%) and 57.7% (95% CI: 53.8%–61.5%) respectively. Conclusions: The VA narratives were not sensitive enough to identify all treatment defaulters, likely related to the lack of structured questions related to defaulting but possibly also related to non-disclosure of HIV status and treatment. Of concern is the high proportion of deceased who had defaulted on treatment.
dc.identifier.apacitationMaqungo, M. (2025). <i>Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS?</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/42067en_ZA
dc.identifier.chicagocitationMaqungo, Monique. <i>"Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS?."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025. http://hdl.handle.net/11427/42067en_ZA
dc.identifier.citationMaqungo, M. 2025. Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS?. . University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/42067en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Maqungo, Monique AB - Background: The South African National Cause-of-Death Validation (2017/18) project utilized the WHO 2016 standard VA questionnaire, which included both structured questions and an open narrative from the next of kin to describe the events surrounding deaths. An unexpected finding was the significant number of HIV/AIDS-related deaths mentioning treatment default in the narrative. Objectives: This study aims to determine the accuracy of VA narratives in identifying ART treatment default by linking data from the national treatment register with NCODV 2017/18 HIV/AIDS related death data. Methods: Secondary analysis of VA data from the NCODV 2017/18 project after linking with TIER.Net data on ART treatment maintained by the Department of Health. Agreement between treatment default identified from VA narratives and from TIER.Net was investigated using Cohen's Kappa (k), and the sensitivity and specificity of the narrative for identifying treatment default was estimated. Results: Data linkage succeeded for 691 (58.9%) deaths, with 62 (5.3%) cases excluded due to inconsistencies. Among the 629 linked cases, 48.3% were identified as treatment defaulters in TIER.Net, compared to 29.4% indicated by VA narratives. The agreement between VA narratives and TIER.Net was 59.1%, with a Cohen's Kappa value of 0.17 (95% CI: 0.10–0.24). Sensitivity and specificity of VA narratives for identifying treatment default were 38.2% (95% CI: 34.4%–42.0%) and 78.8% (95% CI: 75.6%–82.0%) respectively, with positive and negative predictive values of 62.7% (95% CI: 58.9%–66.5%) and 57.7% (95% CI: 53.8%–61.5%) respectively. Conclusions: The VA narratives were not sensitive enough to identify all treatment defaulters, likely related to the lack of structured questions related to defaulting but possibly also related to non-disclosure of HIV status and treatment. Of concern is the high proportion of deceased who had defaulted on treatment. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - human immunodeficiency virus KW - antiretroviral therapy KW - treatment default KW - lost to follow-up KW - verbal autopsy KW - data linkage KW - TIER.Net LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS? TI - Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS? UR - http://hdl.handle.net/11427/42067 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/42067
dc.identifier.vancouvercitationMaqungo M. Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS?. []. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42067en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjecthuman immunodeficiency virus
dc.subjectantiretroviral therapy
dc.subjecttreatment default
dc.subjectlost to follow-up
dc.subjectverbal autopsy
dc.subjectdata linkage
dc.subjectTIER.Net
dc.titleDoes a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS?
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMasters
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