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
. 2021 Nov 1;35(13):2191-2199.
doi: 10.1097/QAD.0000000000003006.

Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019)

Rachael M Burke  1   2 , Marc Y R Henrion  2   3 , Jane Mallewa  4 , Leo Masamba  4 , Thokozani Kalua  5 , McEwen Khundi  2   6 , Ankur Gupta-Wright  1 , Jamie Rylance  2   3 , Stephen B Gordon  2   3 , Clemens Masesa  2   3 , Elizabeth L Corbett  1   2 , Henry C Mwandumba  2   3 , Peter Macpherson  1   2   3
Affiliations

Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019)

Rachael M Burke et al. AIDS. .

Abstract

Objective: To investigate trends in population incidence of HIV-positive hospital admission and risk of in-hospital death among adults living with HIV between 2012 and 2019 in Blantyre, Malawi.

Design: Population cohort study using an existing electronic health information system ('SPINE') at Queen Elizabeth Central Hospital and Blantyre census data.

Methods: We used multiple imputation and negative binomial regression to estimate population age-specific and sex-specific admission rates over time. We used a log-binomial model to investigate trends in risk of in-hospital death.

Results: Of 32 814 adult medical admissions during Q4 2012--Q3 2019, HIV status was recorded for 75.6%. HIV-positive admissions decreased substantially between 2012 and 2019. After imputation for missing data, HIV-positive admissions were highest in Q3 2013 (173 per 100 000 adult Blantyre residents) and lowest in Q3 2019 (53 per 100 000 residents). An estimated 10 818 fewer than expected people with HIV (PWH) [95% confidence interval (CI) 10 068-11 568] were admitted during 2012-2019 compared with the counterfactual situation where admission rates stayed the same throughout this period. Absolute reductions were greatest for women aged 25-34 years (2264 fewer HIV-positive admissions, 95% CI 2002-2526). In-hospital mortality for PWH was 23.5%, with no significant change over time in any age-sex group, and no association with antiretroviral therapy (ART) use at admission.

Conclusion: Rates of admission for adult PWH decreased substantially, likely because of large increases in community provision of HIV diagnosis, treatment and care. However, HIV-positive in-hospital deaths remain unacceptably high, despite improvements in ART coverage. A concerted research and implementation agenda is urgently needed to reduce inpatient deaths among PWH.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Population incidence of hospital admission to medical wards QECH by HIV status Q3 2012 – Q3 2019.
Figure 2
Figure 2. Risk of inpatient death among PLHIV if admitted to Queen Elizabeth Central Hospital, Malawi, Q3 2012 – Q3 2019. Log-binominal model.
See this image and copyright information in PMC

References

    1. Population Health Impact Assessment (PHIA) Project. Malawi Final Report. PHIA Project; [cited 2020 Oct 9]. Available from: https://phia.icap.columbia.edu/malawi-final-report/
    1. Malawi HIV estimates; from Malawi Ministry of Health, Department of HIV and AIDS. Contact details available at https://www.hiv.health.gov.mw/
    1. Meintjes G, Kerkhoff AD, Burton R, Schutz C, Boulle A, Van Wyk G, et al. HIV-Related Medical Admissions to a South African District Hospital Remain Frequent Despite Effective Antiretroviral Therapy Scale-Up. [cited 2019 Sep 16];Medicine (Baltimore) 2015 Dec 18;94(50) [Internet] - PMC - PubMed
    1. Matoga MM, Rosenberg NE, Stanley CC, LaCourse S, Munthali CK, Nsona DP, et al. Inpatient mortality rates during an era of increased access to HIV testing and ART: A prospective observational study in Lilongwe, Malawi. PLOS ONE. 2018 Feb 7;13(2):e0191944. - PMC - PubMed
    1. Barak T, Neo DT, Tapela N, Mophuthegi P, Zash R, Kalenga K, et al. HIV-associated morbidity and mortality in a setting of high ART coverage: prospective surveillance results from a district hospital in Botswana. Journal of the International AIDS Society. 2019;22(12):e25428. - PMC - PubMed

Publication types