title: HIV-Related Medical Admissions to a South African District Hospital Remain Frequent Despite Effective Antiretroviral Therapy Scale-Up.
abstract: The public sector scale-up of antiretroviral therapy (ART) in South Africa commenced in 2004. We aimed to describe the hospital-level disease burden and factors contributing to morbidity and mortality among hospitalized HIV-positive patients in the era of widespread ART availability. Between June 2012 and October 2013, unselected patients admitted to medical wards at a public sector district hospital in Cape Town were enrolled in this cross-sectional study with prospective follow-up. HIV testing was systematically offered and HIV-infected patients were systematically screened for TB. The spectrum of admission diagnoses among HIV-positive patients was documented, vital status at 90 and 180 days ascertained and factors independently associated with death determined. Among 1018 medical admissions, HIV status was ascertained in 99.5%: 60.1% (n = 609) were HIV-positive and 96.1% (n = 585) were enrolled. Of these, 84.4% were aware of their HIV-positive status before admission. ART status was naive in 35.7%, current in 45.0%, and interrupted in 19.3%. The most frequent primary clinical diagnoses were newly diagnosed TB (n = 196, 33.5%), other bacterial infection (n = 100, 17.1%), and acquired immunodeficiency syndrome (AIDS)-defining illnesses other than TB (n = 64, 10.9%). By 90 days follow-up, 175 (29.9%) required readmission and 78 (13.3%) died. Commonest causes of death were TB (37.2%) and other AIDS-defining illnesses (24.4%). Independent predictors of mortality were AIDS-defining illnesses other than TB, low hemoglobin, and impaired renal function. HIV still accounts for nearly two-thirds of medical admissions in this South African hospital and is associated with high mortality. Strategies to improve linkage to care, ART adherence/retention and TB prevention are key to reducing HIV-related hospitalizations in this setting.
authors.affiliation: From the Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine (GM, CS, LB); Department of Medicine, Faculty of Health Sciences, University of Cape Town (GM, RB, CS, SDL); Department of Medicine, Khayelitsha District Hospital, South Africa (GM, RB); Department of Medicine, Imperial College London, London, UK (GM); The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (ADK, SDL); Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA (ADK); Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands (ADK); School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town (AB); Health Impact Assessment Directorate, Western Cape Department of Health (AB); Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town (AB); Department of Medicine, Mitchells Plain Hospital (GVW); Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town (MPN); National Health Laboratory Service, South Africa (MPN); and Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK (SDL).
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Kerkhoff
authors.forename: Rosie
authors.initials: R
authors.lastname: Burton
authors.forename: Charlotte
authors.initials: C
authors.lastname: Schutz
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
authors.forename: Gavin
authors.initials: G
authors.lastname: Van Wyk
authors.forename: Liz
authors.initials: L
authors.lastname: Blumenthal
authors.forename: Mark P
authors.initials: MP
authors.lastname: Nicol
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D006293:Health Promotion; D006760:Hospitalization / Q000706:statistics & numerical data*; D006767:Hospitals, District; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013019:South Africa
chemical_list: D044966:Anti-Retroviral Agents