title: Inpatient mortality of HIV-infected adults in sub-Saharan Africa and possible interventions: a mixed methods review.
abstract: BACKGROUND
  Despite the increased availability of anti-retroviral therapy, in-hospital HIV mortality remains high in sub-Saharan Africa. Reports from Senegal, Malawi, and Tanzania show rates of in-hospital, HIV-related mortality ranging from 24.2% to 44%. This mixed methods review explored the potential causes of preventable in-hospital mortality associated with HIV infections in sub-Saharan Africa in the anti-retroviral era.
  
  
  RESULTS
  Based on our experience as healthcare providers in Africa and a review of the literature we identified 5 health systems failures which may cause preventable in-hospital mortality, including: 1) late presentation of HIV cases, 2) low rates of in-hospital HIV testing, 3) poor laboratory capacity which limits CD4 T-cell testing and the diagnosis of opportunistic infections, 4) delay in initiation of anti-retroviral therapy in-hospital, and 5) problems associated with loss to follow-up upon discharge from hospital.
  
  
  CONCLUSIONS
  Our findings, together with the current available literature, should be used to develop practical interventions that can be implemented to reduce in-hospital mortality.
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Bugando Hill Road, Box 1370, Mwanza, Tanzania. wajangabmk@gmail.com.|Department of Internal Medicine, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania. wajangabmk@gmail.com.
authors.forename: Bahati Mk
authors.initials: BM
authors.lastname: Wajanga
authors.affiliation: Weill Cornell Medical College, New York, NY, USA. laurenwebs@gmail.com.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Webster
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Bugando Hill Road, Box 1370, Mwanza, Tanzania. rnp2002@gmail.com.|Department of Internal Medicine, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania. rnp2002@gmail.com.|Weill Cornell Medical College, New York, NY, USA. rnp2002@gmail.com.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Peck
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Bugando Hill Road, Box 1370, Mwanza, Tanzania. jna2002@med.cornell.edu.|Department of Internal Medicine, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania. jna2002@med.cornell.edu.|Weill Cornell Medical College, New York, NY, USA. jna2002@med.cornell.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Downs
authors.affiliation: Weill Cornell Medical College, New York, NY, USA. kmate@ihi.org.
authors.forename: Kedar
authors.initials: K
authors.lastname: Mate
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Bugando Hill Road, Box 1370, Mwanza, Tanzania. smart.luke@gmail.com.|Department of Internal Medicine, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania. smart.luke@gmail.com.|Weill Cornell Medical College, New York, NY, USA. smart.luke@gmail.com.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Smart
authors.affiliation: Weill Cornell Medical College, New York, NY, USA. dfitzgerald@gheskio.org.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D008297:Male