The impact of HIV on resource utilization by patients with tuberculosis in a tertiary referral hospital, Nairobi, Kenya.
By using routinely collected data and results from research studies at the Infectious Diseases Hospital (IDH), Nairobi, we have begun to determine the scale of the increase in resource utilisation and treatment costs for tuberculosis control services caused by the HIV epidemic. New cases of tuberculosis registered annually at the IDH rose 61%, from 447 in 1985 to 720 in 1990. HIV seroprevalence among patients with tuberculosis rose from 7.5% in 1986 to 42% in 1990. The inpatient mortality rate rose from 8.4% in 1985 to 16.8% in 1989, but fell to 13.5% in 1990. HIV-positive patients were admitted to hospital on 2 or more occasions more often than HIV-negative patients (Relative risk (RR) = 2.46, 95% confidence intervals (CI), 1.1-5.7), but average duration of admission was similar for the 2 groups. Significantly more HIV-positive patients were prescribed antibiotics, antifungal agents, antidiarrhoeal agents, analgesics and corticosteroids than HIV-negative patients. Microbiological investigations, apart from those for tuberculosis, were performed more commonly among HIV-positive patients (RR = 2.0, 95% CI 1.0-4.2). Using this data, the average cost of ideal drug therapy, including antituberculosis drugs and treatment for intercurrent infections and other complications, was estimated using 1992 prices (ECHO, Coulsdon Surrey, UK). The costs were US$16.62 and US$32.94 for HIV-negative patients using 'standard' therapy (2STH/10TH) and short course therapy (2SHRZ/6TH) respectively, and US$41.18 for HIV-positive patients using a short-course regimen without thiacetazone (2EHRZ/6EH). The HIV epidemic is causing both an increase in the numbers of patients requiring treatment and an increase in the average cost of treatment per patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Nunn
P
P
Infectious Diseases Hospital, Kenyatta National Hospital, Nairobi, Kenya.
Gathua
S
S
Kibuga
D
D
Binge
R
R
Brindle
R
R
Odhiambo
J
J
McAdam
K
K
D017088:AIDS-Related Opportunistic Infections / Q000191:economics*; D000328:Adult; D000367:Age Factors; D000995:Antitubercular Agents / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D015528:HIV Seroprevalence; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization; D006782:Hospitals, Special; D006801:Humans; D007630:Kenya; D008297:Male; D014376:Tuberculosis / Q000191:economics*
D000995:Antitubercular Agents