Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Dec 17;20(12):e0338453.
doi: 10.1371/journal.pone.0338453. eCollection 2025.

Causes of community deaths by verbal autopsy among persons with HIV in 33 districts in Zambia, 2020-2023

Priscilla Kapombe  1   2 , Choolwe Jacobs  2 , Mark W Tenforde  1 , Kashala Kamalonga  1 , Diane Morof  1 , Terrence Lo  1 , Mweene Cheelo  3 , Lloyd Mulenga  3 , Sombo Fwoloshi  3 , Cordilia M Himwaze  4 , Patrick Musonda  2 , Mpundu Makasa  2 , Jonas Z Hines  1
Affiliations

Causes of community deaths by verbal autopsy among persons with HIV in 33 districts in Zambia, 2020-2023

Priscilla Kapombe et al. PLoS One. .

Abstract

Zambia has achieved improvements in life expectancy among persons living with HIV (PLHIV) because of high antiretroviral therapy (ART) coverage, which should improve survival due to reductions in AIDS-defining conditions. However, recent estimates of the most common causes of death are not widely available. We utilized mortality surveillance data to report on common causes of death among persons with HIV who died in community settings in Zambia. The Zambian Ministry of Health conducted sentinel mortality surveillance of community deaths in 45 hospitals in 33 of 116 districts from January 2020 through December 2023. Verbal autopsies (VA) were conducted through interviews with relatives or close associates of deceased persons using the 2016 World Health Organization tool. HIV status was reported. A probable cause of death was assigned by a validated computer algorithm (InterVA5). We describe the top assigned causes of death stratified by HIV status. Verbal autopsies were conducted for 67,079 community deaths, of which 11,475 (17.1%) were persons with HIV. The mean age at death was 45 years among persons with HIV and 48 years for persons without HIV (T-test p < 0.001). The most common probable causes of death identified by VA among persons with HIV were HIV/AIDS-related causes (50.4%), cardiac disease (13.1%), pulmonary tuberculosis (7.5%), and digestive neoplasms (3.9%). Leading probable causes in decedents without HIV were cardiac disease (24.9%), stroke (8.5%), and acute respiratory infection including pneumonia (7.6%). Overall, the percentage of deaths attributed to HIV/AIDS-related causes decreased from 11.2% to 7.5% (trend test p < 0.001) and the percentage of cardiac deaths increased from 18.7% to 25.4% (p < 0.001) from 2020 to 2023. These findings support interventions to strengthen the integrated management of noncommunicable diseases in community settings across Zambia. Among persons with HIV, a high percentage of deaths attributed to HIV/AIDS highlights the need to maintain high ART coverage and retention. Strategies, such as increased use of minimally invasive tissue sampling, may improve characterization of the high proportion of deaths attributed to non-specific HIV/AIDS-related causes through VA surveillance.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Trends in the most common verbal autopsy assigned causes of death in Zambia stratified by HIV status, 2020-2023.
Fig 2
Fig 2. Most common verbal autopsy assigned causes of death among persons with HIV in Zambia, 2020-2023*.
Abbreviations: acute resp infect incl pneumonia = acute respiratory infection including pneumonia. *Figure includes most common assigned underlying causes of death by verbal autopsy; 12.4% had another less commonly assigned cause of death.
Fig 3
Fig 3. Top verbal autopsy assigned underlying causes of death in Zambia stratified by age-group among persons with HIV, 2020-2023.
Fig 4
Fig 4. Top verbal autopsy assigned causes of death in Zambia stratified by verbal autopsy questionnaire age category among persons with HIV, 2020-2023.
Fig 5
Fig 5. Top verbal autopsy assigned causes of death in Zambia stratified by place of death among all decedents, 2020-2023.
Fig 6
Fig 6. Top verbal autopsy assigned causes of death in Zambia stratified by place of death among decedents with HIV, 2020-2023.
Fig 7
Fig 7. Top verbal autopsy assigned causes of death in Zambia stratified by place of death among decedents without HIV.
See this image and copyright information in PMC

References

    1. Kavanagh MM, Katz IT, Holmes CB. Reckoning with mortality: global health, HIV, and the politics of data. Lancet. 2020;396(10246):288–90. doi: 10.1016/S0140-6736(20)31046-1 - DOI - PMC - PubMed
    1. UNAIDS. Zambia. https://www.unaids.org/en/regionscountries/countries/zambia. Accessed 2025 November 5.
    1. Moyo-Chilufya M, Maluleke K, Kgarosi K, Muyoyeta M, Hongoro C, Musekiwa A. The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine. 2023;65:102255. doi: 10.1016/j.eclinm.2023.102255 - DOI - PMC - PubMed
    1. Zambia Statistics Agency. 2022 Census of Population and Housing: Preliminary Report. 2022. https://www.zamstats.gov.zm/wp-content/uploads/2023/12/2022-Census-of-Po...
    1. Zambia Statistics Agency. Zambia Vital Statistics Report 2020. Lusaka, Zambia. 2022.