Tuberculosis (TB) and infection with human immuno-deficiency virus (HIV) are leading infectious causes of morbidity particularly in sub-Saharan Africa, which is disproportionately affected by the two epidemics. Kenya is one of the 30 countries with the highest HIV and TB burden in the world. Kenya’s HIV prevalence was estimated to be 4,900 per 100,000 in 2019 while TB prevalence was 558 per 100,000 population in a 2016 survey. Estimates of mortality from TB and HIV were based on modeling of civil registration and vital statistics (CRVS) which may not be accurate in low- and middle-income countries due to under-reporting, poor documentation of causes of death and lack of verification of causes of death. In this thesis, we provide updated estimates of TB and HIV mortality using a variety of data sources including routine surveillance, post mortem surveillance for HIV infection and minimally invasive tissue sampling (MITS). We also evaluated two mortality preventive interventions.

Our mortality studies documented a higher-than-expected HIV prevalence (28.5%) among 846 decedents received by high-volume mortuaries in western Kenya; 17% of deaths were attributable to HIV-infection. Half of HIV-infected decedents had viral load of ≥1,000 copies/milliliter. Among 456 decedents whose causes of death were determined by an expert panel, HIV/AIDS was the leading underlying cause of death (HIV cause-specific mortality rate: 251/100,000 population); TB was ranked 12th among immediate causes of death. Among 176 decedents aged under-five years, malnutrition, malaria, and HIV were the top three underlying causes of death. HIV prevalence among 176 decedents aged under-five years (14%) twenty-fold higher than the estimated prevalence among children in the population (0.7%); 96% of HIV-infected decedents were virally non-suppressed. While Mycobacterium tuberculosis was not detected among under-five decedents, five decedents (four HIV-infected) had been on TB treatment antemortem. Epidemiological analysis of national TB surveillance data showed that 28% of children aged