Proportion of all deaths attributable to HIV/AIDS

Export Indicator

Proportion of all deaths attributable to HIV/AIDS
What it measures

Measuring impact of scaled-up ART programs will not be accomplished simply using ANC sentinel surveillance data. These data will be insufficient to model the estimated number of persons with AIDS and the number of deaths due to AIDS, or to assess trends. Additional information is urgently needed to improve these estimates.
Sample registration approaches offer an important near-term solution to the current state of ignorance (particularly on the levels, causes, and trends of adult health mortality) in countries where good coverage of routine vital registration with reliable cause of death attribution is still years, if not decades, away. Although, by definition, they do not have the coverage of routine systems or censuses, continuous sample registration systems can also complement sources such as decennial censuses, which provide no way of directly monitoring progress in many key indicators at regional or national levels during inter-censal periods.

Rationale
Numerator

Incident death attributable to HIV/AIDS in the resident population aged 18-59

Denominator

All deaths in the resident population aged 18-59

Calculation
Method of measurement

Sample vital registration through verbal autopsy consists of a set of large samples selected to be nationally representative and/or to represent sentinel areas or populations in which sample vital registration and mortality surveillance are carried out over a ten-year cycle. The ‘backbone’ of SAVVY is routine demographic surveillance, continuous (e.g., every 6 months in urban areas) mortality surveillance using verbal autopsy techniques, and the application of a validated income poverty measurement tool. During annual census update rounds, nested sample household surveys are conducted on health service coverage, poverty monitoring, or morbidity. These ‘modules,’ which can be harmonized with the DHS or other national household surveys, can generate enormous amounts of information about service coverage, population health status, food security, or any other topic amenable to household data collection and survey methods. Sampling varies per country, but is a combination of urban/rural. Verbal autopsy methods comprise of an interview by trained personnel with relatives of deceased individuals within a specified time period after death, using standard field instruments and interviewing techniques, with the objective of obtaining the best available information on the symptoms and events during the illness preceding death. Following the interview, the data collected are reviewed, usually by a physician panel, which assimilates all the information and attributes a probable underlying cause of death.

Measurement frequency

Periodic

Disaggregation

Condom type: N/A

Education: N/A

Gender: N/A

Geographic location: N/A

HIV status: N/A

Pregnancy status: N/A

Sector: N/A

Service Type: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

For populations in which a majority of deaths occur outside of health facilities, verbal autopsy techniques are possibly the only systematic way of ascertaining probable cause of death and developing an accurate picture of the cause structure of mortality within that population. The Emergency Plan support for lifelong antiretroviral therapy and other services is being mounted in countries where health systems have been geared to treat acute and episodic illnesses in clinical settings—not to deliver and monitor long-term care and management of chronic conditions that will entail significant outreach and follow-up components. There are no ‘off the shelf’ models for delivering this care in such resource-constrained settings, or for monitoring its successes and failures. Cross-sectional surveys and facility-based systems are unlikely to be able to meet these demands alone. Sample vital registration with verbal autopsy is an adaptable and cost-effective standard for the continuous monitoring of population health (morbidity and mortality) and poverty. SAVVY is an information system based largely on over a decade of experience from Tanzania in developing and packaging the methods, proving their sustainability and cost-effectiveness. It also draws upon the well-established systems of sample registration in India and China.

Further information