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Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS?
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...
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| Format: | Thesis |
| Language: | English English |
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Department of Public Health and Family Medicine
2025
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| _version_ | 1867613186576875520 |
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| access_status_str | Open Access |
| author | Maqungo, Monique |
| author2 | Myer, Landon |
| author_browse | Maqungo, Monique Myer, Landon |
| author_facet | Myer, Landon Maqungo, Monique |
| author_sort | Maqungo, Monique |
| collection | Thesis |
| description | 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. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/42067 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:32:08.355Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/42067 Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS? Maqungo, Monique Myer, Landon Nannan, Nadine Bradshaw, Debbie human immunodeficiency virus antiretroviral therapy treatment default lost to follow-up verbal autopsy data linkage TIER.Net 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. 2025-10-30T13:19:36Z 2025-10-30T13:19:36Z 2025 2025-10-30T12:34:39Z Thesis / Dissertation Masters Masters http://hdl.handle.net/11427/42067 en eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | human immunodeficiency virus antiretroviral therapy treatment default lost to follow-up verbal autopsy data linkage TIER.Net Maqungo, Monique Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS? |
| thesis_degree_str | Master's |
| title | Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS? |
| title_full | Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS? |
| title_fullStr | Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS? |
| title_full_unstemmed | Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS? |
| title_short | Does a verbal autopsy narrative provide accurate information about treatment default for people who have died from HIV/AIDS? |
| title_sort | does a verbal autopsy narrative provide accurate information about treatment default for people who have died from hiv aids |
| topic | human immunodeficiency virus antiretroviral therapy treatment default lost to follow-up verbal autopsy data linkage TIER.Net |
| url | http://hdl.handle.net/11427/42067 |
| work_keys_str_mv | AT maqungomonique doesaverbalautopsynarrativeprovideaccurateinformationabouttreatmentdefaultforpeoplewhohavediedfromhivaids |