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Grønningen E, Nanyaro M, Blomberg B, Hassan S, Ngadaya E, Mustafa T. Mortality among extrapulmonary tuberculosis patients in the HIV endemic setting: lessons from a tertiary level hospital in Mbeya, Tanzania. Sci Rep 2024; 14:10916. [PMID: 38740851 DOI: 10.1038/s41598-024-61589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
Extrapulmonary tuberculosis (EPTB) has received less attention than pulmonary tuberculosis due to its non-contagious nature. EPTB can affect any organ and is more prevalent in people living with HIV. Low- and middle-income countries are now facing the double burden of non-communicable diseases (NCDs) and HIV, complicating the management of patients with symptoms that could be compatible with both EPTB and NCDs. Little is known about the risk of death of patients presenting with symptoms compatible with EPTB. We included patients with a clinical suspicion of EPTB from a tertiary level hospital in Mbeya, Tanzania, to assess their risk of dying. A total of 113 (61%) patients were classified as having EPTB, and 72 (39%) as having non-TB, with corresponding mortality rates of 40% and 41%. Associated factors for mortality in the TB groups was hospitalization and male sex. Risk factors for hospitalization was having disease manifestation at any site other than lymph nodes, and comorbidities. Our results imply that NCDs serve as significant comorbidities amplifying the mortality risk in EPTB. To strive towards universal health coverage, focus should be on building robust health systems that can tackle both infectious diseases, such as EPTB, and NCDs.
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Affiliation(s)
- Erlend Grønningen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, 5020, Bergen, Norway.
- Department of Thoracic Medicine, Haukeland University Hospital, 5021, Bergen, Norway.
| | - Marywinnie Nanyaro
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, United Republic of Tanzania
| | - Bjørn Blomberg
- Department of Clinical Science, Faculty of Medicine, University of Bergen, 5020, Bergen, Norway
- Department of Medicine, National Center for Tropical Infectious Diseases, Haukeland University Hospital, 5021, Bergen, Norway
| | - Shoaib Hassan
- Department of Clinical Science, Faculty of Medicine, University of Bergen, 5020, Bergen, Norway
| | - Esther Ngadaya
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, United Republic of Tanzania
| | - Tehmina Mustafa
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, 5020, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, 5021, Bergen, Norway
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Lombardo AR, Materi J, Caturegli G, Milovanovic M, Martinson N, Calver A, Nonyane BAS, Golub J, Hoffmann CJ, Variava E. Brief Report: Changing Characteristics Among In-Hospital HIV Deaths: An 11-Year Retrospective Review of a Regional Hospital in South Africa. J Acquir Immune Defic Syndr 2023; 94:185-189. [PMID: 37757855 DOI: 10.1097/qai.0000000000003249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/05/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Elevated HIV-associated mortality persists, despite a notable decline with the expansion of antiretroviral therapy (ART). In South Africa, the relative majority of deaths occur in health facilities, providing an opportunity to track decedent characteristics. SETTING We analyzed data from 14,870 adult patients who died between 2008 and 2018 at Klerksdorp/Tshepong Hospital Complex in South Africa. METHODS Recorded data included demographics, causes of death, HIV status, ART, and tuberculosis (TB) history. We present summary statistics and results from linear, log-binomial, and multinomial regressions to quantify changes over time. RESULTS Over the study period, the median age of decedents with HIV in the hospital increased from 39.3 to 43.4 years, and there was a switch to male predominance (46%-54%). Those who died at a younger age (<40 years) remained more likely to be HIV-positive than the older age group, despite the overall proportion of HIV-positivity decreasing over time. The proportion of decedents with HIV ever started on ART increased from 21% to 67%. The proportion of HIV patients dying from TB and AIDS-defining illnesses decreased from 31% to 22%. CONCLUSIONS We noted a shift in deaths over time to more men and older individuals, whereas the burden of HIV was heaviest on the younger age groups. Advanced HIV disease remained an important cause of mortality. We also observed an increase in less-traditional opportunistic illnesses among those with HIV, including malignancy, cardiovascular disease, and kidney disease. The high proportion of patients on ART who died prematurely requires further research and interventions.
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Affiliation(s)
| | - Joshua Materi
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Jonathan Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Kanyama C, Chagomerana MB, Chawinga C, Ngoma J, Shumba I, Kumwenda W, Armando B, Kumwenda T, Kumwenda E, Hosseinipour MC. Implementation of tuberculosis and cryptococcal meningitis rapid diagnostic tests amongst patients with advanced HIV at Kamuzu Central Hospital, Malawi, 2016–2017. BMC Infect Dis 2022; 22:224. [PMID: 35247971 PMCID: PMC8897937 DOI: 10.1186/s12879-022-07224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cryptococcal meningitis (CM) and tuberculosis (TB) remain leading causes of hospitalization and death amongst people living with HIV, particularly those with advanced HIV disease. In hospitalized patients, prompt diagnosis of these diseases may improve patient outcomes. The advanced HIV rapid diagnostic tests such as determine TB urine lipoarabinomannan lateral flow assay (urine LAM), urine X-pert MTB/RIF assay (urine X-pert), and serum/blood cryptococcal antigen test (serum CrAg) are recommended but frequently not available in many resource-limited settings. We describe our experience providing these tests in a routine hospital setting. Method From 1 August 2016 to 31 January 2017, a prospective cohort study to diagnose TB and Cryptococcal meningitis using point of care tests was conducted in the medical wards at Kamuzu Central Hospital, in Lilongwe, Malawi. The tests offered were PIMA CD4 cell count, serum CrAg, urine LAM, and urine X-pert. The testing was integrated into an existing HIV/TB treatment room on the wards and performed close to admission time. Patients were followed until discharge or death in the ward. Results We included 438 HIV-positive patients; 76% had a previously known HIV diagnosis (87% already on ART). We measured CD4 count in 365/438 (83%), serum CrAg in 301/438 (69%), urine LAM in 363/438 (83%), and urine X-pert in 292/438 (67%). The median CD4 count was 144 cells/ml (IQR 46–307). Serum CrAg positivity rate was 23 /301 (8%) and CM was confirmed by CSF Crag in 13/23 (56%). The majority of CM patients 9/13 (69%) started antifungal therapy within two days of diagnosis. Urine LAM and urine X-pert positivity rates were 81/363(22%) and (14/292 (5%) respectively. The positivity rate of urine LAM was higher in patients with low CD4 cell counts (< 100 cells/ml) and low BMI (< 18.5). Most patients with positive urine LAM started TB treatment on the same day. Despite the early diagnosis and treatment of TB and CM, the inpatient mortality was high; 30% and 25% respectively. Conclusion Although advanced HIV rapid diagnostic tests are recommended, one key challenge in implementation is the limited trained personnel administering the tests. Despite the effective use of the point of care tests in the clinical care of hospitalized TB and CM patients, mortality among these patients remained unacceptably high. Henceforth we need to train other cadres apart from nurses, clinicians, and laboratory technicians to conduct the tests. There is an urgent need to identify and modify other risks of death from TB and CM. Trial registration: Malawi National Health Science Research committee: Protocol # 1144. Registered 2 July 2014 and University Of North Carolina IRB #: UNCPM 21412, approved 13th October 2014.
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Ford N, Patten G, Rangaraj A, Davies MA, Meintjes G, Ellman T. Outcomes of people living with HIV after hospital discharge: a systematic review and meta-analysis. THE LANCET HIV 2022; 9:e150-e159. [PMID: 35245507 PMCID: PMC8905089 DOI: 10.1016/s2352-3018(21)00329-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/03/2021] [Accepted: 12/13/2021] [Indexed: 12/19/2022]
Abstract
Background The identification and appropriate management of people with advanced HIV disease is a key component in the HIV response. People with HIV who are hospitalised are at a higher risk of death, a risk that might persist after discharge. The aims of this study were to estimate the frequency of negative post-discharge outcomes, and to determine risk factors for such outcomes in people with HIV. Methods Using a broad search strategy combining terms for hospital discharge and HIV infection, we searched MEDLINE via PubMed and Embase from Jan 1, 2003 to Nov 30, 2021 to identify studies reporting outcomes among people with HIV following discharge from hospital. We estimated pooled proportions of readmissions and deaths after hospital discharge using random-effects models. We also did subgroup analyses by setting, region, duration of follow-up, and advanced HIV status at admission, and sensitivity analyses to assess heterogeneity. Findings We obtained data from 29 cohorts, which reported outcomes of people living with HIV after hospital discharge in 92 781 patients. The pooled proportion of patients readmitted to hospital after discharge was 18·8% (95% CI 15·3–22·3) and 14·1% (10·8–17·3) died post-discharge. In sensitivity analyses, no differences were identified in the proportion of patients who were readmitted or died when comparing studies published before 2016 with those published after 2016. Post-discharge mortality was higher in studies from Africa (23·1% [16·5–29·7]) compared with the USA (7·5% [4·4–10·6]). For studies that reported both post-discharge mortality and readmission, the pooled proportion of patients who had this composite adverse outcome was 31·7% (23·9–39·5). Heterogeneity was moderate, and largely explained by patient status and linkage to care. Reported risk factors for readmission included low CD4 cell count at admission, longer length of stay, discharge against medical advice, and not linking to care following discharge; inpatient treatment with antiretroviral therapy (ART) during hospitalisation was protective of post-discharge mortality. Interpretation More than a quarter of patients with HIV had an adverse outcome after hospital discharge with no evidence of improvement in the past 15 years. This systematic review highlights the importance of ensuring post-discharge referral and appropriate management, including ART, to reduce mortality and readmission to hospital among this group of high-risk patients. Funding Bill & Melinda Gates Foundation. Translations For the French and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Nathan Ford
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Gabriela Patten
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ajay Rangaraj
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Graeme Meintjes
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Tom Ellman
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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Tunnage J, Yates A, Nwoga C, Sing'oei V, Owuoth J, Polyak CS, Crowell TA. Hepatitis and tuberculosis testing are much less common than HIV testing among adults in Kisumu, Kenya: results from a cross-sectional assessment. BMC Public Health 2021; 21:1143. [PMID: 34130663 PMCID: PMC8204299 DOI: 10.1186/s12889-021-11164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background Kenya has a high burden of HIV, viral hepatitis, and tuberculosis. Screening is necessary for early diagnosis and treatment, which reduces morbidity and mortality across all three illnesses. We evaluated testing uptake for HIV, viral hepatitis, and tuberculosis in Kisumu, Kenya. Methods Cross-sectional data from adults aged 18–35 years who enrolled in a prospective HIV incidence cohort study from February 2017 to May 2018 were analyzed. A questionnaire was administered to each participant at screening for study eligibility to collect behavioral characteristics and to assess prior testing practices. Among participants without a history of previously-diagnosed HIV, multivariable robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV testing in the 12 months prior to enrollment. A hierarchical model was used to test for differential access to testing due to spatial location. Results Of 671 participants, 52 (7.7%) were living with HIV, 308 (45.9%) were female, and the median age was 24 (interquartile range 21–28) years. Among 651 (97.0%) who had ever been tested for HIV, 400 (61.2%) reported HIV testing in the past 6 months, 129 (19.7%) in the past 6–12 months, and 125 (19.1%) more than one year prior to enrollment. Any prior testing for viral hepatitis was reported by 8 (1.2%) participants and for tuberculosis by 51 (7.6%). In unadjusted models, HIV testing in the past year was more common among females (PR 1.08 [95% CI 1.01, 1.17]) and participants with secondary education or higher (PR 1.10 [95% CI 1.02, 1.19]). In the multivariable model, only secondary education or higher was associated with recent HIV testing (adjusted PR 1.10 [95% CI 1.02, 1.20]). Hierarchical models showed no geographic differences in HIV testing across Kisumu subcounties. Conclusions Prior HIV testing was common among study participants and most had been tested within the past year but testing for tuberculosis and viral hepatitis was far less common. HIV testing gaps exist for males and those with lower levels of education. HIV testing infrastructure could be leveraged to increase access to testing for other endemic infectious diseases.
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Affiliation(s)
- Joshua Tunnage
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Valentine Sing'oei
- HJF Medical Research International, Kisumu, Kenya.,Army Medical Research Directorate-Africa, Kisumu, Kenya
| | - John Owuoth
- HJF Medical Research International, Kisumu, Kenya.,Army Medical Research Directorate-Africa, Kisumu, Kenya
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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Workie KL, Birhan TY, Angaw DA. Predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy in Metema Hospital, Northwest Ethiopia: a retrospective follow-up study. AIDS Res Ther 2021; 18:27. [PMID: 33952282 PMCID: PMC8097881 DOI: 10.1186/s12981-021-00353-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/26/2021] [Indexed: 01/16/2023] Open
Abstract
Background Globally Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is an ongoing public health issue associated with high morbidity and mortality. Efforts have been made to reduce HIV/AIDS-related morbidity and mortality by delivering antiretroviral therapy. However, the incidence and predictors of mortality in border areas like Metema were not investigated. This study aimed to assess predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy at Metema Hospital. Methods Retrospective follow-up study was employed among ART patients from January 1, 2013, to December 30, 2018. Data were entered in Epi-data 3.1 and exported to STATA 14 for analysis. Kaplan–Meier and Log-Rank test was used to compare survival differences among categories of different variables. In bi-variable analysis p-values < 0.20 were entered into a multivariable analysis. Multivariate Weibull model was used to measure the risk of death and identify the significant predictors of death. Variables that were statistically significant at p-value < 0.05 were concluded as predictors of mortality. Result A total of 542 study participants were included. The overall incidence rate was 6.7 (95% CI: 5.4–8.4) deaths per 100 person-years of observation. Being male (HR = 2.4; 95% CI: 1.24–4.62), STAGE IV (HR = 5.64; 95% CI: 2.53–12.56), stage III (HR = 3.31; 95% CI: 1.35–8.10), TB-coinfection (HR = 3.71; 95% CI: 1.59–8.64), low hemoglobin (HR = 4.14; 95% CI: 2.18–7.86), BMI ≤ 15.4 kg/m2 (HR = 2.45; 95% CI: 1.17–5.10) and viral load > 1000 copy/ml (HR = 6.70; 95% CI: 3.4–13.22) were found to be a significant predictor for mortality among HIV patients on ART treatment. Conclusion The incidence of death was high. Being male, viral load, those with advanced STAGE (III & IV), TB co-infected, low BMI, and low hemoglobin were at a higher risk of mortality. Special attention should be given to male patients and high public interventions needed among HIV patients on ART to reduce the mortality rate. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00353-z.
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Barak T, Neo DT, Tapela N, Mophuthegi P, Zash R, Kalenga K, Perry MEO, Malane M, Makhema J, Lockman S, Shapiro R. HIV-associated morbidity and mortality in a setting of high ART coverage: prospective surveillance results from a district hospital in Botswana. J Int AIDS Soc 2019; 22:e25428. [PMID: 31850683 PMCID: PMC6918506 DOI: 10.1002/jia2.25428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Antiretroviral therapy (ART) has significantly improved survival in Africa in recent years. In Botswana, where adult HIV prevalence is 21.9%, AIDS-related mortality is estimated to have declined by 58% between 2005 and 2013 following the initial wide-spread introduction of ART, and ART coverage has steadily increased reaching 84% in 2016. However, there remains little data about the burden of HIV and its impact on mortality in the hospital setting where most deaths occur. We aimed to describe the burden of HIV and related morbidity and mortality among hospitalized medical patients in a district hospital in southern Botswana in the era of widespread ART coverage. METHODS We prospectively reviewed medical admissions to Scottish Livingstone Hospital from December 2015 to November 2017 and recorded HIV status, demographics, clinical characteristics and final diagnoses at discharge, death or transfer. We ascertained outcomes and determined factors associated with mortality. Results were compared with similar surveillance data collected at the same facility in 2011 to 2012. RESULTS A total of 2316 admissions occurred involving 1969 patients; 42.4% were of HIV-positive patients, 46.9% of HIV-negative patients and 10.7% of patients with unknown HIV status. Compared to HIV-negative patients, HIV-positive patients had younger age (mean 42 vs. 64 years, p < 0.0001) and higher mortality (22.2% vs. 18.0%, p = 0.03). Tuberculosis was the leading diagnosis among mortality cases in both groups but accounted for a higher proportion of deaths among HIV-positive admissions (44.5%) compared with HIV-negative admissions (19.4%, p < 0.0001). Compared with similar surveillance in 2011 to 2012, HIV prevalence was lower (42.4% vs. 47.6%, p < 0.01), and among HIV-positive admissions: ART coverage was higher (72.2% vs. 56.2%, p < 0.0001), viral load suppression was similar (78.6% vs. 80.3%, p = 0.77), CD4 counts were higher (55.0% vs. 44.6% with CD4 ≥200 cells/mm3 , p < 0.001), mortality was similar (22.2 vs. 22.7%, p = 0.93), tuberculosis diagnoses increased (27.5% vs. 20.1%, p < 0.01) and tuberculosis-associated mortality was higher (35.9% vs. 24.7%, p = 0.05). CONCLUSIONS Despite high ART-coverage in Botswana, HIV-positive patients continue to be disproportionately represented among hospital admissions and deaths. Deaths from tuberculosis may be contributing to lack of reduction in inpatient mortality. Our findings suggest that control of HIV and tuberculosis remain top priorities for reducing inpatient mortality in Botswana.
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Affiliation(s)
- Tomer Barak
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- Department of MedicineBeth Israel Deaconess Medical CenterBostonMAUSA
- Department of MedicineScottish Livingstone HospitalMolepololeBotswana
| | - Dayna T Neo
- Department of Obstetrics and GynecologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Neo Tapela
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
- Division of Global Health & EquityBrigham & Women's HospitalBostonMAUSA
| | | | - Rebbeca Zash
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- Division of Infectious DiseaseBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Ketenga Kalenga
- Department of MedicineScottish Livingstone HospitalMolepololeBotswana
| | - Melissa EO Perry
- Department of Genitourinary MedicineWestern Health and Social Care TrustLondonderryUnited Kingdom
| | - Mompati Malane
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
| | - Joseph Makhema
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
| | - Shahin Lockman
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Roger Shapiro
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- Division of Infectious DiseaseBeth Israel Deaconess Medical CenterBostonMAUSA
- Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMAUSA
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Haachambwa L, Kandiwo N, Zulu PM, Rutagwera D, Geng E, Holmes CB, Sinkala E, Claassen CW, Mugavero MJ, Wa Mwanza M, Turan JM, Vinikoor MJ. Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia. Open Forum Infect Dis 2019; 6:ofz336. [PMID: 31660330 PMCID: PMC6778319 DOI: 10.1093/ofid/ofz336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/15/2019] [Indexed: 12/30/2022] Open
Abstract
Background We characterized the extent of antiretroviral therapy (ART) experience and postdischarge mortality among hospitalized HIV-infected adults in Zambia. Methods At a central hospital with an opt-out HIV testing program, we enrolled HIV-infected adults (18+ years) admitted to internal medicine using a population-based sampling frame. Critically ill patients were excluded. Participants underwent a questionnaire regarding their HIV care history and CD4 count and viral load (VL) testing. We followed participants to 3 months after discharge. We analyzed prior awareness of HIV-positive status, antiretroviral therapy (ART) use, and VL suppression (VS; <1000 copies/mL). Using Cox proportional hazards regression, we assessed risk factors for mortality. Results Among 1283 adults, HIV status was available for 1132 (88.2%), and 762 (67.3%) were HIV-positive. In the 239 who enrolled, the median age was 36 years, 59.7% were women, and the median CD4 count was 183 cells/mm3. Active tuberculosis or Cryptococcus coinfection was diagnosed in 82 (34.3%); 93.3% reported prior awareness of HIV status, and 86.2% had ever started ART. In the 64.0% with >6 months on ART, 74.4% had VS. The majority (92.5%) were discharged, and by 3 months, 48 (21.7%) had died. Risk of postdischarge mortality increased with decreasing CD4, and there was a trend toward reduced risk in those treated for active tuberculosis. Conclusions Most HIV-related hospitalizations and deaths may now occur among ART-experienced vs -naïve individuals in Zambia. Development and evaluation of inpatient interventions are needed to mitigate the high risk of death in the postdischarge period.
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Affiliation(s)
- Lottie Haachambwa
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia.,School of Medicine, University of Zambia, Lusaka, Zambia.,School of Medicine, University of Maryland at Baltimore, Baltimore, Maryland
| | - Nyakulira Kandiwo
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Paul M Zulu
- Zambia National Public Health Institute, Lusaka, Zambia
| | - David Rutagwera
- University Teaching Hospital HIV AIDS Programme, Lusaka, Zambia
| | - Elvin Geng
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Charles B Holmes
- Johns Hopkins University, Baltimore, Maryland.,Center for Global Health and Quality, Georgetown University School of Medicine, Washington, District of Columbia
| | - Edford Sinkala
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia.,School of Medicine, University of Zambia, Lusaka, Zambia
| | - Cassidy W Claassen
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia.,School of Medicine, University of Zambia, Lusaka, Zambia.,School of Medicine, University of Maryland at Baltimore, Baltimore, Maryland
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mwanza Wa Mwanza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J Vinikoor
- School of Medicine, University of Zambia, Lusaka, Zambia.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Hoffmann CJ, Milovanovic M, Cichowitz C, Kinghorn A, Martinson NA, Variava E. Readmission and death following hospitalization among people with HIV in South Africa. PLoS One 2019; 14:e0218902. [PMID: 31269056 PMCID: PMC6608975 DOI: 10.1371/journal.pone.0218902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Additional approaches are needed to identify and provide targeted interventions to populations at continued risk for HIV-associated mortality. We sought to describe care utilization and mortality following an index hospitalization for people with HIV in South Africa. METHODS We conducted a prospective cohort study among hospitalized patients admitted to medicine wards at a single hospital serving a large catchment area. Participants were followed to 6 months post-discharge. Hospital records were used to describe overall admission numbers and inpatient mortality. Poisson regression was used to assess for associations between readmission or death and independent variables. RESULTS Of 124 enrolled participants, 121 lived to hospital discharge. At the time of discharge the median length of stay of sampled patients was 5.5 days and 105 (87%) participants were referred for follow-up, most within 2 weeks of discharge. By 6 months post-discharge, only 18% of participants had attended the clinic to which they were referred and within the referred timeframe; 64 (53%) had been readmitted at least once and 31 (26%) had died. Self-reported skipping care due to difficulty in access (relative risk 1.3, p = 0.02) and not attending follow-up care on time or at the scheduled clinic or not attending clinic at all (relative risk 1.8 and 2.4, respectively, p = 0.001) were associated with readmission or mortality. CONCLUSIONS The post-hospital period is a period of medical vulnerability and high mortality. Improving post-hospital retention in care may reduce post-hospital mortality.
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Affiliation(s)
- Christopher J. Hoffmann
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | | | - Cody Cichowitz
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | | | | | - Ebrahim Variava
- Department of Medicine, Tshepong Hospital, Klerksdorp, South Africa
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Ingabire PM, Semitala F, Kamya MR, Nakanjako D. Delayed Antiretroviral Therapy (ART) Initiation among Hospitalized Adults in a Resource-Limited Settings: A Challenge to the Global Target of ART for 90% of HIV-Infected Individuals. AIDS Res Treat 2019; 2019:1832152. [PMID: 31057959 PMCID: PMC6463639 DOI: 10.1155/2019/1832152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/02/2019] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) initiation in hospital settings, where individuals often present with undiagnosed, untreated, advanced HIV disease, is not well understood. METHODS A cross-sectional study was conducted to determine a period prevalence of cART initiation within two weeks of eligibility, as determined at hospitalization. Using a pretested and precoded data extraction tool, data on cART initiation status and reason for not initiating cART was collected. Phone calls were made to patients that had left the hospital by the end of the two-week period. Delayed cART initiation was defined as failure to initiate cART within two weeks. Sociodemographic characteristics, WHO clinical stage, CD4 count, cART initiation status, and reasons for delayed cART initiation were extracted and analyzed. RESULTS Overall, 386 HIV-infected adults were enrolled, of whom 289/386 (74.9%) had delayed cART initiation, 77/386 (19.9%) initiated cART, and 20/386 (5.2%) were lost-to-follow-up, within two weeks of cART eligibility. Of 289 with delayed ART initiation, 94 (32.5%) died within two weeks of cART eligibility. Patients with a CD4 cell count≥ 50 cells/μl and who resided in ≥8 kilometers from the hospital were more likely to have delayed cART initiation [adjusted odds ratio (AOR) 2.34, 95% CI: 1.33-4.10, p value 0.003; and AOR 1.92, 95% CI: 1.09-3.40, p value 0.025; respectively]. CONCLUSION Up to 75% of hospitalized HIV-infected, cART-naïve, cART-eligible patients did not initiate cART and had a 33% pre-ART mortality rate within two weeks of eligibility for cART. Hospital based strategies to hasten cART initiation during hospitalization and electronic patient tracking systems could promote active linkage to HIV treatment programs, to prevent HIV/AIDS-associated mortality in resource-limited settings.
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Affiliation(s)
- Prossie Merab Ingabire
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- St. Francis Hospital, Nsambya, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Semitala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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11
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Cichowitz C, Pellegrino R, Motlhaoleng K, Martinson NA, Variava E, Hoffmann CJ. Hospitalization and post-discharge care in South Africa: A critical event in the continuum of care. PLoS One 2018; 13:e0208429. [PMID: 30543667 PMCID: PMC6292592 DOI: 10.1371/journal.pone.0208429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/17/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES The purpose of this prospective cohort study is to characterize the event of acute hospitalization for people living with and without HIV and describe its impact on the care continuum. This study describes care-seeking behavior prior to an index hospitalization, inpatient HIV testing and diagnosis, discharge instructions, and follow-up care for patients for patients being discharged from a single hospital in South Africa. METHODS A convenience sample of adult patients was recruited from the medical wards of a tertiary care facility. Baseline information at the time of hospital admission, subsequent diagnoses, and discharge instructions were recorded. Participants were prospectively followed with phone calls for six months after hospital discharge. Descriptive analyses were performed. RESULTS A total of 293 participants were enrolled in the study. Just under half (46%) of the participants were known to be living with HIV at the time of hospital admission. Most participants (97%) were given a referral for follow-up care; often that appointment was scheduled within two weeks of discharge (64%). Only 36% of participants returned to care within the first month, 50% returned after at least one month had elapsed, and 14% of participants did not return for any follow up. CONCLUSIONS Large discrepancies were found between the type of post-discharge follow-up care recommended by providers and what patients were able to achieve. The period of time following hospital discharge represents a key transition in care. Additional research is needed to characterize patients' risk following hospitalization and to develop patient-centered interventions.
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Affiliation(s)
- Cody Cichowitz
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Rachael Pellegrino
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | | | | | - Ebrahim Variava
- Perinatal HIV Research Unit, Gauteng, South Africa
- Department of Medicine, Tshepong Hospital, Klerksdorp, South Africa
| | - Christopher J. Hoffmann
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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12
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Luma HN, Mboringong F, Doualla MS, Nji M, Donfack OT, Kamdem F, Ngouadjeu E, Lepka FK, Mapoure YN, Mbatchou HB. Mortality in Hospitalised HIV/AIDS Patients in a Tertiary Centre in Sub-Saharan Africa: Trends Between 2007 and 2015, Causes and Associated Factors. Open AIDS J 2018. [DOI: 10.2174/1874613601812010162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
With easy accessibility to combination Antiretroviral Therapy (cART), mortality amongst hospitalized HIV/AIDS patients needs to be described.
Objective:
We aimed at determining the trends, causes and factors associated with in-hospital mortality amongst HIV/AIDS patients in the Douala General Hospital.
Methods:
We retrospectively reviewed hospitalisation records of HIV/AIDS patients hospitalized in the medical wards of the DGH from 2007 to 2015. Four cause-of-death categories were defined: 1. Communicable conditions and AIDS-defining malignancies, 2. Chronic non-communicable conditions and non-AIDS defining malignancies’, 3. Other non-communicable conditions and 4. Unknown conditions. Logistic regression was used to determine factors associated mortality.
Results:
We analyzed 891 eligible files. The mean age was 43 (standard deviation (SD): 10) years and median length of hospital stay was 9 (interquatile range (IQR)4 - 15) days. The overall all-cause mortality was 23.5% (95% CI: 20.8% - 26.4%). The category - communicable conditions and AIDS defining malignancies represented 79.9%, of deaths and this remained constant for each year during the study period. Tuberculosis was the most common specific cause of death (23.9%). Patients who had two (OR=2.35, 95%CI: 1.35 - 4.06) and more than two (OR=4.23, 95%CI: 1.62 – 11.12) opportunistic infections, a haemoglobin level less than 10g/l (OR=2.38, 95%CI: 1.58 - 3.59) had increased odds of dying.
Conclusion:
In-hospital mortality is high amongst HIV/AIDS patients at the Douala general hospital. The category - communicable conditions and AIDS defining malignancies - is still the main underlying cause of death. We hope that our findings will help to develop interventions aimed at reducing in-hospital mortality.
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13
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Matoga MM, Rosenberg NE, Stanley CC, LaCourse S, Munthali CK, Nsona DP, Haac B, Hoffman I, Hosseinipour MC. Inpatient mortality rates during an era of increased access to HIV testing and ART: A prospective observational study in Lilongwe, Malawi. PLoS One 2018; 13:e0191944. [PMID: 29415015 PMCID: PMC5802850 DOI: 10.1371/journal.pone.0191944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 01/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the era of increased access to HIV testing and antiretroviral treatment (ART), the impact of HIV and ART status on inpatient mortality in Malawi is unknown. METHODS We prospectively followed adult inpatients at Kamuzu Central Hospital medical wards in Lilongwe, Malawi, between 2011 and 2012, to evaluate causes of mortality, and the impact of HIV and ART status on mortality. We divided the study population into five categories: HIV-negative, new HIV-positive, ART-naïve patients, new ART-initiators, and ART-experienced. We used multivariate binomial regression models to compare risk of death between categories. RESULTS Among 2911 admitted patients the mean age was 38.5 years, and 50% were women. Eighty-one percent (81%) of patients had a known HIV status at the time of discharge or death. Mortality was 19.4% and varied between 13.9% (HIV-negative patients) and 32.9% (HIV-positive patients on ART ≤1 year). In multivariable analyses adjusted for age, sex and leading causes of mortality, being new HIV-positive (RR = 1.64 95% CI: 1.16-2.32), ART-naive (RR = 2.28 95% CI: 1.66-2.32) or being a new ART-initiator (RR = 2.41 95% CI: 1.85-3.14) were associated with elevated risk of mortality compared to HIV-negative patients. ART-experienced patients had comparable mortality (RR = 1.33 95% CI: 0.94-1.88) to HIV-negative patients. CONCLUSION HIV related mortality remains high among medical inpatients, especially among HIV-positive patients who recently initiated ART or have not started ART yet.
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Affiliation(s)
| | - Nora E. Rosenberg
- University of North Carolina Project, Lilongwe, Malawi
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Sylvia LaCourse
- University of Washington, Seattle, Washington, United States of America
| | | | | | - Bryce Haac
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Irving Hoffman
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Mina C. Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi
- University of North Carolina, Chapel Hill, North Carolina, United States of America
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14
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Iwuji CC, Lessells RJ. HIV assessment and testing for hospital in-patients: still a weak link in the cascade. Public Health Action 2017; 7:243. [PMID: 29344440 DOI: 10.5588/pha.17.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Collins C Iwuji
- Department of Global Health & Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, Falmer, United Kingdom
| | - Richard J Lessells
- KwaZulu-Natal Research Innovation and Sequencing Platform, Department of Laboratory Medicine & Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
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15
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Bos JC, Mistício MC, Nunguiane G, Mathôt RAA, van Hest RM, Prins JM. Paracetamol clinical dosing routine leads to paracetamol underexposure in an adult severely ill sub-Saharan African hospital population: a drug concentration measurement study. BMC Res Notes 2017; 10:671. [PMID: 29202789 PMCID: PMC5715499 DOI: 10.1186/s13104-017-3016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background Hospitals in sub-Saharan Africa (SSA) continue to receive high numbers of severely ill (HIV-infected) patients with physical pain that may suffer from hepatic and renal dysfunction. Paracetamol is widely used for pain relief in this setting but it is unknown whether therapeutic drug concentrations are attained. The aim of this study was to assess the occurrence of therapeutic, sub-therapeutic and toxic paracetamol concentrations in SSA adult hospital population. Methods In a cross-sectional study, plasma paracetamol concentrations were measured in patients with an oral prescription in a referral hospital in Mozambique. From August to November 2015, a maximum of four blood samples were drawn on different time points for paracetamol concentration measurement and biochemical analysis. Study endpoints were the percentage of participants with therapeutic (≥ 10 and ≤ 20 mg/L), sub-therapeutic (< 10 mg/L) and toxic (> 75 mg/L) concentrations. Results Seventy-six patients with a median age of 37 years, a body mass index of 18.2, a haemoglobin concentration of 10.3 g/dL and an albumin of 29 g/L yielded 225 samples. 13.4% of participants had one or more therapeutic paracetamol concentrations. 86.6% had a sub-therapeutic concentration at all time points and 70.2% had two or more concentrations below the lower limit of quantification. No potentially toxic concentrations were found. Conclusions Routine oral dosing practices in a SSA hospital resulted in substantial underexposure to paracetamol. Palliation is likely to be sub-standard and oral palliative drug pharmacokinetics and dispensing procedures in this setting need further investigation.
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Affiliation(s)
- Jeannet C Bos
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Mabor C Mistício
- Faculty of Health Sciences, Research Centre for Infectious Diseases (CIDI), Catholic University of Mozambique, Rua Marquês do Soveral 960, C.P. 821, Beira, Mozambique
| | - Ginto Nunguiane
- Faculty of Health Sciences, Research Centre for Infectious Diseases (CIDI), Catholic University of Mozambique, Rua Marquês do Soveral 960, C.P. 821, Beira, Mozambique
| | - Ron A A Mathôt
- Division of Clinical Pharmacology, Department of Hospital Pharmacy, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Reinier M van Hest
- Division of Clinical Pharmacology, Department of Hospital Pharmacy, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jan M Prins
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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16
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Moodley Y. The impact of an unknown HIV serostatus on inpatient mortality. Pan Afr Med J 2017; 28:285. [PMID: 29942417 PMCID: PMC6011002 DOI: 10.11604/pamj.2017.28.285.11860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/14/2017] [Indexed: 12/02/2022] Open
Abstract
Introduction Determining HIV serostatus is crucial for linking HIV-infected patients to appropriate care, which might reduce their risk of subsequent morbidity and mortality. A recent South African study demonstrated a potentially harmful association between an unknown HIV serostatus and rehospitalisation. The impact of an unknown HIV status on inpatient mortality has not yet been established in that setting, which formed the impetus for the current study. Methods This was an unmatched case-control analysis of adult patient data collected as part of a demographic survey at the Hlabisa Hospital, South Africa between October 2009 and February 2014. Cases were defined as patients who suffered inpatient mortality, while controls were patients who did not suffer inpatient mortality. A sample size of 92 cases and 276 controls was used in this study. Patient data related to age, gender, distance between referral clinic and the hospital, HIV serostatus (HIV-negative, HIV-positive or an unknown HIV serostatus) and comorbidity were analysed using recommended methods for unmatched case-control studies. Results When potential confounders were accounted for, we found an unknown HIV serostatus to be associated with an almost 8-fold increase in the odds of inpatient mortality when compared with patients who were known HIV-negative (Odds Ratio: 7.64, 95% Confidence Interval: 1.11-52.33, p = 0.038). Conclusion An unknown HIV serostatus was independently associated with a higher odds of inpatient mortality. This finding highlights the potential benefit of adopting an “opt-out” approach to HIV counseling and testing. Further research on this topic is required.
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Affiliation(s)
- Yoshan Moodley
- Discipline of Anaesthesiology and Critical Care Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
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17
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Denning DW. Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized. Philos Trans R Soc Lond B Biol Sci 2017; 371:rstb.2015.0468. [PMID: 28080991 PMCID: PMC5095544 DOI: 10.1098/rstb.2015.0468] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 12/17/2022] Open
Abstract
Deaths from AIDS (1 500 000 in 2013) have been falling more slowly than anticipated with improved access to antiretroviral therapy. Opportunistic infections account for most AIDS-related mortality, with a median age of death in the mid-30s. About 360 000 (24%) of AIDS deaths are attributed to tuberculosis. Fungal infections deaths in AIDS were estimated at more than 700 000 deaths (47%) annually. Rapid diagnostic tools and antifungal agents are available for these diseases and would likely have a major impact in reducing deaths. Scenarios for reduction of avoidable deaths were constructed based on published outcomes of the real-life impact of diagnostics and generic antifungal drugs to 2020. Annual deaths could fall for cryptococcal disease by 70 000, Pneumocystis pneumonia by 162 500, disseminated histoplasmosis by 48 000 and chronic pulmonary aspergillosis by 33 500, with approximately 60% coverage of diagnostics and antifungal agents; a total of >1 000 000 lives saved over 5 years. If factored in with the 90–90–90 campaign rollout and its effect, AIDS deaths could fall to 426 000 annually by 2020, with further reductions possible with increased coverage. Action could and should be taken by donors, national and international public health agencies, NGOs and governments to achieve the UNAIDS mortality reduction target, by scaling up capability to detect and treat fungal disease in AIDS. This article is part of the themed issue ‘Tackling emerging fungal threats to animal health, food security and ecosystem resilience’.
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Affiliation(s)
- David W Denning
- Global Action Fund for Fungal Infections (GAFFI), Rue de l'Ancien-Port 14, 1211 Geneva 1, Geneva, Switzerland .,The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester M23 9LT, UK
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18
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Cummings MJ, Goldberg E, Mwaka S, Kabajaasi O, Vittinghoff E, Katamba A, Cattamanchi A, Kenya-Mugisha N, Davis JL, Jacob ST. The sixth vital sign: HIV status assessment and severe illness triage in Uganda. Public Health Action 2017; 7:245-250. [PMID: 29584800 DOI: 10.5588/pha.17.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/27/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Four in-patient health facilities in western Uganda. Objective: To determine the impact of an innovative multi-modal quality improvement program on human immunodeficiency virus (HIV) status assessment and the impact of HIV status on severe illness conditions and mortality. Design: This was a staggered, pre-post quasi-experimental study designed to assess a multi-modal intervention (collaborative improvement meetings, audit and feedback, clinical mentoring) for improving quality of care following formal training in the management of severe illness in low-income settings. Results: From August 2014 to May 2015, 5759 patients were hospitalized, of whom 2451 (42.6%) had their HIV status assessed; 395 (16.1%) were HIV-infected. HIV-infected patients were significantly more likely to meet criteria for shock (27.5% vs. 15.1%, risk ratio [RR] 1.8, 95% confidence interval [CI] 1.7-1.9, P < 0.001) and severe respiratory distress (6.7% vs. 4.3%, RR 1.5, 95%CI 1.2-2.0, P < 0.001), and were significantly more likely to die in hospital (12.0% vs. 2.9%, RR 4.1, 95%CI 3.2-5.4, P < 0.001). There was no evidence of improved HIV status assessment during the intervention period (36.5% vs. 44.8%, +8.3%, 95%CI -8.3 to 24.8, P = 0.33). Conclusions: Hospitalized HIV-infected patients in western Uganda are at high risk for severe illness and death. Novel quality improvement strategies are needed to enhance hospital-based HIV testing in high-burden settings.
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Affiliation(s)
- M J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - E Goldberg
- ImpactMatters, New York, New York, USA.,Walimu, Kampala, Uganda
| | | | | | - E Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - A Katamba
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - J L Davis
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA.,Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - S T Jacob
- Walimu, Kampala, Uganda.,Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
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Karwa R, Maina M, Mercer T, Njuguna B, Wachira J, Ngetich C, Some F, Jakait B, Owino RK, Gardner A, Pastakia S. Leveraging peer-based support to facilitate HIV care in Kenya. PLoS Med 2017; 14:e1002355. [PMID: 28708845 PMCID: PMC5510806 DOI: 10.1371/journal.pmed.1002355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rakhi Karwa and colleagues discuss a program in which peer navigators support care for people with HIV at a Kenyan hospital.
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Affiliation(s)
- Rakhi Karwa
- College of Pharmacy, Purdue University, West Lafayette, Indiana, United States of America
- College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- * E-mail:
| | - Mercy Maina
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Timothy Mercer
- College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | | | - Juddy Wachira
- College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Celia Ngetich
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Fatma Some
- College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Beatrice Jakait
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Regina K. Owino
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Adrian Gardner
- College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sonak Pastakia
- College of Pharmacy, Purdue University, West Lafayette, Indiana, United States of America
- College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
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20
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Seyoum D, Degryse JM, Kifle YG, Taye A, Tadesse M, Birlie B, Banbeta A, Rosas-Aguirre A, Duchateau L, Speybroeck N. Risk Factors for Mortality among Adult HIV/AIDS Patients Following Antiretroviral Therapy in Southwestern Ethiopia: An Assessment through Survival Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030296. [PMID: 28287498 PMCID: PMC5369132 DOI: 10.3390/ijerph14030296] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/27/2017] [Accepted: 03/09/2017] [Indexed: 01/06/2023]
Abstract
Introduction: Efforts have been made to reduce HIV/AIDS-related mortality by delivering antiretroviral therapy (ART) treatment. However, HIV patients in resource-poor settings are still dying, even if they are on ART treatment. This study aimed to explore the factors associated with HIV/AIDS-related mortality in Southwestern Ethiopia. Method: A non-concurrent retrospective cohort study which collected data from the clinical records of adult HIV/AIDS patients, who initiated ART treatment and were followed between January 2006 and December 2010, was conducted, to explore the factors associated with HIV/AIDS-related mortality at Jimma University Specialized Hospital (JUSH). Survival times (i.e., the time from the onset of ART treatment to the death or censoring) and different characteristics of patients were retrospectively examined. A best-fit model was chosen for the survival data, after the comparison between native semi-parametric Cox regression and parametric survival models (i.e., exponential, Weibull, and log-logistic). Result: A total of 456 HIV patients were included in the study, mostly females (312, 68.4%), with a median age of 30 years (inter-quartile range (IQR): 23–37 years). Estimated follow-up until December 2010 accounted for 1245 person-years at risk (PYAR) and resulted in 66 (14.5%) deaths and 390 censored individuals, representing a median survival time of 34.0 months ( IQR: 22.8–42.0 months). The overall mortality rate was 5.3/100 PYAR: 6.5/100 PYAR for males and 4.8/100 PYAR for females. The Weibull survival model was the best model for fitting the data (lowest AIC). The main factors associated with mortality were: baseline age (>35 years old, AHR = 3.8, 95% CI: 1.6–9.1), baseline weight (AHR = 0.93, 95% CI: 0.90–0.97), baseline WHO stage IV (AHR = 6.2, 95% CI: 2.2–14.2), and low adherence to ART treatment (AHR = 4.2, 95% CI: 2.5–7.1). Conclusion: An effective reduction in HIV/AIDS mortality could be achieved through timely ART treatment onset and maintaining high levels of treatment adherence.
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Affiliation(s)
- Dinberu Seyoum
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels B-1082, Belgium.
- Department of Statistics, Natural Science College, Jimma University, Jimma, PO Box 378, Ethiopia.
| | - Jean-Marie Degryse
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels B-1082, Belgium.
- Department Public Health and Primary Care, KU Leuven, Leuven B-3000, Belgium.
| | - Yehenew Getachew Kifle
- Department of Statistics and Operations Research, University of Limpopo, Sovenga, 0727, South Africa.
| | - Ayele Taye
- School of Mathematical and Statistical Science, Hawassa University, P.O. Box 05, Ethiopia.
| | - Mulualem Tadesse
- Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, P.O. Box 378, Ethiopia.
| | - Belay Birlie
- Department of Statistics, Natural Science College, Jimma University, Jimma, PO Box 378, Ethiopia.
| | - Akalu Banbeta
- Department of Statistics, Natural Science College, Jimma University, Jimma, PO Box 378, Ethiopia.
| | - Angel Rosas-Aguirre
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels B-1082, Belgium.
- Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima 15000, Peru.
| | - Luc Duchateau
- Department of Comparative Physiology and Biometrics, Ghent University, Ghent B-9000, Belgium.
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels B-1082, Belgium.
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21
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Govender K, Suleman F, Moodley Y. Clinical risk factors for in-hospital mortality in older adults with HIV infection: findings from a South African hospital administrative dataset. Pan Afr Med J 2017; 26:126. [PMID: 28533849 PMCID: PMC5429410 DOI: 10.11604/pamj.2017.26.126.11000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/12/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction The proportion of older South African adults (aged ≥50 years old) with HIV infection requiring hospitalization is likely to increase in the near future. Clinical risk factors for in-hospital mortality (IHM) in these patients are not well described. We aimed to identify clinical risk factors associated with IHM and their overall contribution towards IHM in older South African adults with HIV infection. Methods Clinical data for 690 older adults with HIV infection was obtained from the hospital administrative database at the Hlabisa Hospital in KwaZulu-Natal, South Africa. Logistic regression was used to determine independent clinical risk factors for IHM. Population-attributable fractions (PAFs) were calculated for all independent clinical risk factors identified. Results Male gender (p=0.005), CD4 count <350 cells/mm3 (p=0.035), unknown CD4 count (p=0.048), tuberculosis (p=0.033) and renal failure (p=0.013) were independently associated with IHM. Male gender contributed the most to IHM (PAF=0.22), followed by unknown CD4 count (PAF=0.14), tuberculosis (PAF=0.12), renal failure (PAF=0.06) and CD4 count <350 cells/mm3 (PAF=0.01). Conclusion Although further research is required to confirm our findings, there is potential for these clinical risk factors identified in our study to be used to stratify patient risk and reduce IHM in older adults with HIV infection.
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Affiliation(s)
- Kumeren Govender
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.,Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, South Africa
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, South Africa
| | - Yoshan Moodley
- Discipline of Anaesthesiology and Critical Care Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
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Chen L, Pan X, Ma Q, Yang J, Xu Y, Zheng J, Wang H, Zhou X, Jiang T, Jiang J, He L, Jiang J. HIV cause-specific deaths, mortality, risk factors, and the combined influence of HAART and late diagnosis in Zhejiang, China, 2006-2013. Sci Rep 2017; 7:42366. [PMID: 28198390 PMCID: PMC5309804 DOI: 10.1038/srep42366] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/10/2017] [Indexed: 11/30/2022] Open
Abstract
To examine patterns of human immunodeficiency virus (HIV) cause-specific deaths, risk factors, and the effect of interactions on mortality, we conducted a retrospective cohort study in Zhejiang, China, from 2006 to 2013. All data were downloaded from the acquired immune deficiency syndrome (AIDS) Prevention and Control Information System. The Cox proportional hazards model was used to assess predictors of cause-specific death. The relative excess risk due to interaction and ratio of hazard ratios (RHR) were calculated for correlations between HAART, late diagnosis, and age. A total of 13,812 HIV/AIDS patients were enrolled with 31,553 person-years (PY) of follow-up. The leading causes of death of HIV patients were accidental death and suicide (21.5%), and the leading cause of death for those with AIDS was AIDS-defining disease (76.4%). Both additive and multiplicative scale correlations were found between receiving HAART and late diagnosis, with RERI of 5.624 (95% CI: 1.766-9.482) and RHR of 2.024 (95% CI: 1.167-2.882). The effects of HAART on AIDS-related mortalities were affected by late diagnosis. Early detection of HIV infection and increased uptake of HAART are important for greater benefits in terms of lives saved.
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Affiliation(s)
- Lin Chen
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Jiezhe Yang
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Yun Xu
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Jinlei Zheng
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Hui Wang
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Xin Zhou
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Tingting Jiang
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Jun Jiang
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Lin He
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
| | - Jianmin Jiang
- Zhejiang Provincial Center for Diseases Control and Prevention, 3399 Binsheng road, Binjiang District, Hangzhou, Zhejiang, China
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Ji Y, Wang Z, Shen J, Chen J, Yang J, Qi T, Song W, Tang Y, Liu L, Shen Y, Zhang R, Lu H. Trends and characteristics of all-cause mortality among HIV-infected inpatients during the HAART era (2006-2015) in Shanghai, China. Biosci Trends 2017; 11:62-68. [PMID: 28132999 DOI: 10.5582/bst.2016.01195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Globally, the overall mortality rate among HIV-infected patients has significantly declined during the HAART era. Deaths among HIV-infected inpatients need to be characterized in order to formulate intervention strategies to further improve medical care for this population and their prognosis. In the current study, deaths among HIV-infected inpatients from 2006 to 2015 at a medical center for HIV infection and AIDS patient care in Shanghai, China were retrospectively analyzed. Trends in mortality rates and the proportion of deaths caused by AIDS or non-AIDS-related illnesses were evaluated. A bivariate analysis was performed to identify the demographic and clinical factors associated with AIDS or non-AIDS-related deaths among HIV-infected inpatients. Among 6,473 HIV-infected patients who were discharged from 2006 to 2015, 326 deaths (5.04%) were identified. The yearly mortality rate declined significantly over time (χ2 = 34.41, p < 0.001). Results revealed that most deaths were attributed to AIDS-related illnesses (76.9 %, 233/303), and the proportion of causes of death did not change significantly over time (χ2 = 13.847, p = 0.127). Bivariate analysis identified characteristic factors associated with AIDS-related mortality. Compared to patients who died of non-AIDS illnesses, patients who died of AIDS-related illnesses had a CD4+ T cell count lower than 50 cells/μL (OR 4.587, 2.377-8.850) and fewer liver (OR 0.391, 0.177-0.866) or renal comorbidities (OR 0.188, 0.067-0.523) on admission. Results indicated that the overall in-hospital mortality rate among HIV-infected patients has declined over the past decade. However, AIDS-related illnesses were still the major causes of deaths among HIV-infected inpatients, suggesting that further efforts are needed to improve AIDS care in China.
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Affiliation(s)
- Yongjia Ji
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
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Allain TJ, Aston S, Mapurisa G, Ganiza TN, Banda NP, Sakala S, Gonani A, Heyderman RS, Peterson I. Age Related Patterns of Disease and Mortality in Hospitalised Adults in Malawi. PLoS One 2017; 12:e0168368. [PMID: 28099438 PMCID: PMC5242517 DOI: 10.1371/journal.pone.0168368] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The epidemic of non-communicable diseases (NCDs) in low and middle income countries (LMICs) is widely recognised as the next major challenge to global health. However, in many LMICs, infectious diseases are still prevalent resulting in a "double burden" of disease. With increased life expectancy and longevity with HIV, older adults may particularly be at risk of this double burden. Here we describe the relative contributions of infections and NCDs to hospital admissions and mortality, according to age, in Malawi's largest hospital. METHODS Primary diagnosis on discharge/death, mortality rates, and HIV status were recorded prospectively on consecutive adult medical in-patients over 2 years using an electronic medical records system. Diagnoses were classified as infections or NCDs and analysed according to age and gender. FINDINGS 10,191 records were analysed. Overall, infectious diseases, particularly those associated with HIV, were the leading cause of admission. However, in adults ≥55 years, NCDs were the commonest diagnoses. In adults <55 years 71% of deaths were due to infections whereas in adults ≥55 years 56% of deaths were due to NCDs. INTERPRETATION Infectious diseases are still the leading cause of adult admission to a central hospital in Malawi but in adults aged ≥55 years NCDs are the most frequent diagnoses. HIV was an underlying factor in the majority of adults with infections and was also present in 53% of those with NCDs. These findings highlight the need for further health sector shifts to address the double burden of infectious and NCDs, particularly in the ageing population.
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Affiliation(s)
| | - Stephen Aston
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Gugulethu Mapurisa
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Thokozani N. Ganiza
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Servace Sakala
- Ministry of Health, Queen Elizabeth Hospital, Blantyre, Malawi
| | - Andrew Gonani
- Ministry of Health, Queen Elizabeth Hospital, Blantyre, Malawi
| | | | - Ingrid Peterson
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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25
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Peck RN, Wang RJ, Mtui G, Smart L, Yango M, Elchaki R, Wajanga B, Downs JA, Mteta K, Fitzgerald DW. Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study. J Acquir Immune Defic Syndr 2016; 73:522-530. [PMID: 27846069 PMCID: PMC5129656 DOI: 10.1097/qai.000000000001107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION 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.
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Affiliation(s)
- Robert N. Peck
- Weill Bugando School of Medicine
- Bugando Medical Centre
- Weill Cornell Medical College
| | - Richard J. Wang
- Weill Cornell Medical College
- University of California, San Francisco
| | - Graham Mtui
- Weill Bugando School of Medicine
- Bugando Medical Centre
| | - Luke Smart
- Weill Bugando School of Medicine
- Bugando Medical Centre
- Weill Cornell Medical College
| | - Missana Yango
- Weill Bugando School of Medicine
- University of Dodoma School of Medicine
| | | | | | - Jennifer A. Downs
- Weill Bugando School of Medicine
- Bugando Medical Centre
- Weill Cornell Medical College
| | - Kien Mteta
- Weill Bugando School of Medicine
- Bugando Medical Centre
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Nabayigga B, Kellett J, Opio MO. The alertness, gait and mortality of severely ill patients at two months after admission to a resource poor sub-Saharan hospital--Why is post-discharge surveillance not routine everywhere? Eur J Intern Med 2016; 28:25-31. [PMID: 26777607 DOI: 10.1016/j.ejim.2015.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mortality, the first level of the first tier of the Outcomes Measures Hierarchy used to assess the value of health care, is the only hospital outcome usually measured. Gait and alertness after discharge are important to patients; they capture much of the second level of the first tier of the hierarchy, and are required to more fully assess the benefits, value and quality of care. AIM To assess the alertness, gait and mortality of severely ill patients at two months after admission to a resource poor sub-Saharan hospital. METHODS 193 severely ill patients admitted to a Ugandan hospital were followed up for up to 60 days. RESULTS 34% of patients died, 52% were alert and calm with a stable independent gait, 2% had an unstable gait, 6% were bedridden and 7% were lost to follow-up within 60 days of admission: 7.4% of patients discharged alert with a stable gait died within 30 days and 13.9% within 60 days; 26.9% of patients discharged without a stable gait died within 60 days. Sixty day mortality was 5% if patients had a stable independent gait on admission, 25% if they had an unstable gait or needed help to walk, and 50% if they were bedridden. Simple logistic regression models based on cheap easily available data predicted 30 day mortality, alertness and gait (c statistic of both models 0.89 SE 0.03). CONCLUSION In a resource poor setting gait and alertness assessments are of prognostic value, and practical and informative methods of patient follow-up.
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Affiliation(s)
- Barbara Nabayigga
- Medical Wards, St. Joseph's Kitovu Health Care Complex, Masaka, Uganda
| | - John Kellett
- Thunder Bay Regional Health Sciences Center, Thunder Bay, Ontario, Canada.
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Mhozya H, Bintabara D, Kibusi S, Neilson E, Mpondo BC. Late-stage disease at presentation to an HIV clinic in eastern Tanzania: A retrospective cross-sectional study. Malawi Med J 2015; 27:125-127. [PMID: 26952140 PMCID: PMC4761702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Late presentation and delayed treatment initiation is associated with poor outcomes in patients with HIV. Little is known about the stage at which HIV patients present at HIV clinics in Tanzania. AIM This study aimed at determining the proportion of HIV patients presenting with WHO clinical stages 3 and 4 disease, and the level of immunity at the time of enrollment at the care and treatment center. METHODS A retrospective cross-sectional study was conducted among 366 HIV-infected adults attending HIV clinic at Mwananyamala Hospital in Dar es Salaam, Tanzania. Data were obtained from the care and treatment clinic database. RESULTS Late stage disease at the time of presentation was found in 276 (75.4%) of the patients; out of whom 153 (41.8%) presented with CD4 count <200 cells/ul and 229 (62.6%) presented with WHO clinical stage 3 or 4 at the time of clinic enrollment. Strategies to improve early diagnosis and treatment initiation should be improved.
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Affiliation(s)
- H Mhozya
- Buguruni Health Centre, Ilala Municipal, Dar es Salaam, Tanzania
| | - D Bintabara
- School of Nursing and Public health, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - S Kibusi
- School of Nursing and Public health, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - E Neilson
- School of Medicine, College of Health Sciences, University of Dodoma, Dodoma, Tanzania; Peace Corps/SEED Global Health Service Partnership, Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA
| | - B C Mpondo
- School of Medicine, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
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