title: Verbal autopsy-assigned causes of death among adults being investigated for TB in South Africa.
abstract: Adults being investigated for TB in South Africa experience high mortality, yet causes of death (CoD) are not well defined. We determined CoD in this population using verbal autopsy (VA), and compared HIV- and TB-associated CoD using physician-certified verbal autopsy (PCVA) and InterVA-4 software.
  
  
  
  All contactable consenting caregivers of participants who died during a trial comparing Xpert MTB/RIF to smear microscopy were interviewed using the WHO VA tool. CoD were assigned using PCVA and InterVA-4. Kappa statistic (K) and concordance correlation coefficient (CCC) were calculated for comparison.
  
  
  
  Among 231 deaths, relatives of 137 deceased were interviewed. Of the 137 deceased 76 (55.4%) were males, median age 41 years (IQR 33-50). PCVA assigned 70 (51.1%) TB immediate CoD (44 [62.8%] pulmonary TB; 26 [37.1%] extra-pulmonary TB); 21 (15.3%) HIV/AIDS-related; and 46 (33.5%) other CoD. InterVA-4 assigned 48 (35.0%) TB deaths; 49 (35.7%) HIV/AIDS-related deaths; and 40 (29.1%) other CoD. Agreement between PCVA and InterVA-4 CoD was slight at individual level (K=0.20; 95% CI 0.10-0.30) and poor at population level (CCC 0.67; 95% CI 0.38-0.99).
  
  
  
  TB and HIV are leading CoD among adults being investigated for TB. PCVA and InterVA agreement at individual level was slight and poor at population level. VA methodology needs further development where TB and HIV are common.
authors: The Aurum Institute, Parktown, Johannesburg, South Africa nmaraba@auruminstitute.org.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors: Noriah
authors: N
authors: Maraba
authors: London School of Hygiene & Tropical Medicine, UK.
authors: Aaron S
authors: AS
authors: Karat
authors: Division of Public Health Surveillance and Response, National Institute for Communicable diseases of the National Health Laboratory Service, Johannesburg, South Africa.
authors: Kerrigan
authors: K
authors: McCarthy
authors: The Aurum Institute, Parktown, Johannesburg, South Africa.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|London School of Hygiene & Tropical Medicine, UK.|Advancing Treatment and Care for TB and HIV, South African Medical Research Council Collaborating Centre for HIV/TB.
authors: Gavin J
authors: GJ
authors: Churchyard
authors: The Aurum Institute, Parktown, Johannesburg, South Africa.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors: Salome
authors: S
authors: Charalambous
authors: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt); School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå 90187, Sweden.|INDEPTH Network, Accra, Ghana.
authors: Kathleen
authors: K
authors: Kahn
authors: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|London School of Hygiene & Tropical Medicine, UK.|School of Nursing, Public Health, Africa Center for Population Health, University of Kwa-Zulu Natal.
authors: Alison D
authors: AD
authors: Grant
authors: The Aurum Institute, Parktown, Johannesburg, South Africa.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors: Violet
authors: V
authors: Chihota
mesh_terms: D000328:Adult; D001344:Autopsy; D001431:Bacteriological Techniques / Q000379:methods; D002423:Cause of Death / Q000639:trends; D016000:Cluster Analysis; D060085:Coinfection / Q000401:mortality* / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000473:pathology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D012984:Software; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000401:mortality / Q000473:pathology
keywords: Causes of death; InterVA; Physician assigned verbal autopsy; Tuberculosis; Verbal autopsy