BACKGROUND: HIV mortality surveillance data allow countries to monitor trends in deaths among people living with HIV to assess the impact and progress of HIV prevention and treatment investments; and in combination with HIV incidence data, to measure HIV epidemic control. However, mortality surveillance systems are underdeveloped in most countries supported by the U.S President’s Emergency Plan for AIDS Relief (PEPFAR). We conducted a review to describe various mortality surveillance methods used to fill data gaps.
METHODS: We searched peer-reviewed literature using Medline and Google Scholar and grey literature using Google’s search engine to identify methods for mortality surveillance using “HIV”, “mortality”, and “surveillance” as search terms. We only included studies in English from 1990 onwards. We collected information on the strengths, weaknesses, requirements of each method, and country examples.
RESULTS: HIV mortality surveillance methods include routine death reporting to civil registration and vital statistics (CRVS) systems, verbal autopsies (VA), sample vital registration with VA, burial systems, and biomarker-based sentinel surveys (including minimally invasive tissue sampling and mortuary surveillance). CRVS is the gold standard and captures all deaths and causes of deaths (CoD). Most PEPFAR countries do not have representative, reliable national CRVS systems. Malawi has recently started a sub-national electronic death reporting system. VAs can be conducted with the next of kin to determine CoD. However, VAs require trained interviewers, and either physician coded or automated assignment of CoD. VAs have been conducted in several countries including Uganda and South Africa. Blood and other samples collected from cadavers can be tested for HIV and other biomarkers, though this may require laboratory infrastructure. Kenya piloted mortuary surveillance in Nairobi in 2015 and replicated it in Kisumu in 2018.
CONCLUSIONS: In the absence of national CRVS systems, or while countries are implementing and strengthening their CRVS systems, other surveillance strategies can be implemented at the sub-national or sentinel level to fill the gaps in mortality data. Timely mortality data can inform HIV prevention, care, and treatment interventions and programs.

Download the e-Poster (PDF)