Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 16;6(10):ofz336.
doi: 10.1093/ofid/ofz336. eCollection 2019 Oct.

Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia

Lottie Haachambwa  1   2   3 , Nyakulira Kandiwo  1 , Paul M Zulu  4 , David Rutagwera  5 , Elvin Geng  6 , Charles B Holmes  7   8 , Edford Sinkala  1   2 , Cassidy W Claassen  1   2   3 , Michael J Mugavero  9 , Mwanza Wa Mwanza  10 , Janet M Turan  11 , Michael J Vinikoor  2   9
Affiliations

Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia

Lottie Haachambwa et al. Open Forum Infect Dis. .

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.

Keywords: Africa; HIV infection; care continuum; health systems; hospitalization.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Recruitment flow diagram.
Figure 2.
Figure 2.
HIV care continuum at the time of admission for hospitalized adults. Abbreviations: ART, antiretroviral therapy; VL, viral load.
See this image and copyright information in PMC

References

    1. Meintjes G, Kerkhoff AD, Burton R, et al. . HIV-related medical admissions to a South African district hospital remain frequent despite effective antiretroviral therapy scale-up. Medicine 2015; 94:e2269. - PMC - PubMed
    1. Hansoti B, Kelen GD, Quinn TC, et al. . A systematic review of emergency department based HIV testing and linkage to care initiatives in low resource settings. PLoS One 2017; 12:e0187443. - PMC - PubMed
    1. LaCourse SM, Chester FM, Matoga M, et al. . Implementation of routine counselor-initiated opt-out HIV testing on the adult medical ward at Kamuzu Central Hospital, Lilongwe, Malawi. J Acquir Immune Defic Syndr 2015; 69:e31. - PMC - PubMed
    1. Long LC, Evans D, Rosen S, et al. . Can routine inpatient mortality data improve HIV mortality estimates? Inpatient mortality at an urban hospital in South Africa. S Afr Med J 2018; 108:870–5. - PubMed
    1. Osler M, Hilderbrand K, Goemaere E, et al. . The continuing burden of advanced HIV disease over 10 years of increasing antiretroviral therapy coverage in South Africa. Clin Infect Dis 2018; 66:118–25. - PMC - PubMed