title: HIV testing and epidemiology in a hospital-based surgical cohort in Malawi.
abstract: BACKGROUND
  Despite the high prevalence of HIV in adults (11 %) in Malawi, testing among surgical patients is not routine. We examined the feasibility of universal opt-out HIV testing and counseling (HTC) on the surgical wards of Kamuzu Central Hospital in Lilongwe, Malawi, and sought to further delineate the role of HIV in surgical presentation and outcome.
  
  
  METHODS
  We reviewed HTC and surgical admission records from May to October 2011 and compared these data to data collected prospectively on patients admitted from November 2011 through April 2012, after universal HTC implementation.
  
  
  RESULTS
  Prior to universal HTC, 270 of the 2,606 (10.4 %) surgical admissions were tested; 13 % were HIV-infected. After universal HTC implementation, HTC counselors reviewed 1,961 of the 2,488 admissions (79 %): 310 (16 %) had known status (157 seropositive, 153 seronegative) and 1,651 had unknown status (81 %). Among those with unknown status, 97 % (1,598, of 64 % of all admissions) accepted testing, of whom 9 % were found to be HIV-infected. Patients with longer lengths of stay (LOS) (mean = 11 vs. 5 days, p < 0.01) and those who underwent surgical intervention (odds ratio [OR] 2.5; confidence interval [CI] 2.0-3.1) were more likely to have a known status on discharge. HIV was more prevalence in patients with infection and genital/anal warts or ulcers and lower in trauma patients. HIV-positive patients received less surgical intervention (OR 0.69; CI 0.52-0.90), but there was no association between HIV status and length of stay or mortality.
  
  
  CONCLUSIONS
  Universal opt-out HTC on the surgical wards was well accepted and increased the proportion of patients tested. High HIV prevalence in this setting merits implementation of universal HTC.
authors: University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors: Bryce E
authors: BE
authors: Haac
authors: Anthony G
authors: AG
authors: Charles
authors: Mitch
authors: M
authors: Matoga
authors: Sylvia M
authors: SM
authors: LaCourse
authors: Dominic
authors: D
authors: Nonsa
authors: Mina
authors: M
authors: Hosseinipour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D018580:Mandatory Testing / Q000592:standards*; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D055815:Young Adult
references: Arch Surg. 2006 Dec;141(12):1238-45
references: 17178967
references: Malawi Med J. 2006 Sep;18(3):103-10
references: 27529005
references: BMJ. 1997 Apr 12;314(7087):1077-81; discussion 1081-4
references: 9133887
references: AIDS. 1995 Jun;9(6):585-8
references: 7662197
references: J Acquir Immune Defic Syndr. 2011 Aug;57 Suppl 2:S64-7
references: 21857298
references: Afr J Med Med Sci. 2006 Dec;35 Suppl:77-83
references: 18050778
references: World J Surg. 2009 May;33(5):899-909
references: 19280251
references: Lancet. 2009 Jan 3;373(9657):48-57
references: 19038438
references: Trans R Soc Trop Med Hyg. 2003 Jan-Feb;97(1):91-6
references: 12886812
references: Lancet. 2012 Sep 15;380(9846):e5
references: 22981116
references: N Engl J Med. 2011 Aug 11;365(6):493-505
references: 21767103
references: Ann R Coll Surg Engl. 2006 Jan;88(1):46-51
references: 16460640
references: World J Surg. 1994 Sep-Oct;18(5):753-7
references: 7975695
references: J R Soc Med. 1990 May;83(5):315-8
references: 2380948
references: Lancet. 2008 May 10;371(9624):1603-11
references: 18468544
references: Lancet. 2011 Jul 16;378(9787):256-68
references: 21684591
references: Trans R Soc Trop Med Hyg. 2007 Feb;101(2):176-82
references: 16814822
references: Dis Colon Rectum. 1995 Nov;38(11):1169-75
references: 7587759