title: Relationship between HIV serostatus, CD4 count and rehospitalisation: Potential implications for health systems strengthening in South Africa.
abstract: BACKGROUND
  Despite three decades of scientific response to HIV/AIDS, the generalised HIV epidemic continues to persist in South Africa. There is growing acknowledgement that health system strengthening will be critical in tackling HIV/AIDS. Patient rehospitalisation is an important quality benchmark of health service delivery, but there is currently limited data on rehospitalisation of patients with HIV/AIDS in South Africa, a setting with a high burden of HIV disease.
  
  
  OBJECTIVE
  To determine the relationship between combined HIV serostatus and CD4 count, and rehospitalisation in South Africa.
  
  
  METHODS
  This study was a retrospective analysis of data from 11,362 non-surgical adult patients who attended the Hlabisa Hospital in South Africa. Data related to patient age, gender, HIV serostatus, CD4 count (for HIV-positive patients) and comorbidity were analysed through univariate (Fisher's Exact or χ2tests) and multivariate (Cox regression) statistical methods to determine associations with rehospitalisation within 1 month (acute rehospitalisation) or 12 months (long term rehospitalisation).
  
  
  RESULTS
  An HIV-positive serostatus with CD4 count < 350 cells/mm3or an HIV-positive serostatus with an unknown CD4 count were independently associated with a higher risk of acute (p= 0.010 andp= 0.003) and long term rehospitalisation (p< 0.001 for both categories) when compared with an HIV-negative serostatus group.
  
  
  CONCLUSIONS
  HIV-positive individuals with immune deficiency, or lacking a CD4 count measurement are at risk of rehospitalisation. Strengthening primary healthcare service delivery of these key affected inpatient populations should be a priority.
authors.affiliation: Discipline of Anaesthesiology and Critical Care Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Yoshan
authors.initials: Y
authors.lastname: Moodley
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tomita
keywords: CD4 count; HIV; patient re-admission; rehospitalisation; serostatus