title: Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study.
abstract: BACKGROUND
  Little is known about outcomes after hospitalization for HIV-infected adults in sub-Saharan Africa. We determined 12-month, posthospital mortality rates in HIV-infected vs. uninfected adults and predictors of mortality.
  
  
  METHODS
  In this prospective cohort study, we enrolled adults admitted to the medical wards of a public hospital in northwestern Tanzania. We conducted standardized questionnaires, physical examinations, and basic laboratory analyses including HIV testing. Participants or proxies were called at 1, 3, 6, and 12 months to determine outcomes. Predictors of in-hospital and posthospital mortality were determined using logistic regression. Cox regression models were used to analyze mortality incidence and associated factors. To confirm our findings, we studied adults admitted to another government hospital.
  
  
  RESULTS
  We enrolled 637 consecutive adult medical inpatients: 38/143 (26.6%) of the HIV-infected adults died in hospital vs. 104/494 (21.1%) of the HIV-uninfected adults. Twelve-month outcomes were determined for 98/105 (93.3%) vs. 352/390 (90.3%) discharged adults, respectively. Posthospital mortality was 53/105 (50.5%) for HIV-infected adults vs. 126/390 (32.3%) for HIV-uninfected adults (adjusted P = 0.006). The 66/105 (62.9%) HIV-infected adults who attended clinic within 1 month after discharge had significantly lower mortality than the other HIV-infected adults [adjusted hazards ratio = 0.17 (0.07-0.39), P < 0.001]. Adults admitted to a nearby government hospital had similar high rates of posthospital mortality.
  
  
  CONCLUSIONS
  Posthospital mortality is disturbingly high among HIV-infected adult inpatients in Tanzania. The posthospital period may offer a window of opportunity to improve survival in this population. Interventions are urgently needed and should focus on increasing posthospital linkage to primary HIV care.
authors.affiliation: *Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania; †Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania; ‡Center for Global Health, Weill Cornell Medical College, New York, NY; §University of California, San Francisco, San Francisco, CA; ‖Department of Medicine, University of Dodoma School of Medicine, Dodoma, Tanzania; ¶Weill Cornell Medical College-Qatar, Doha, Qatar; and #Office of the Director General, Bugando Medical Center, Mwanza, Tanzania.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Peck
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wang
authors.forename: Graham
authors.initials: G
authors.lastname: Mtui
authors.forename: Luke
authors.initials: L
authors.lastname: Smart
authors.forename: Missana
authors.initials: M
authors.lastname: Yango
authors.forename: Rim
authors.initials: R
authors.lastname: Elchaki
authors.forename: Bahati
authors.initials: B
authors.lastname: Wajanga
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Downs
authors.forename: Kien
authors.initials: K
authors.lastname: Mteta
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011320:Primary Health Care; D011446:Prospective Studies; D016019:Survival Analysis; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult