Frequent Detection of Undiagnosed HIV Within Emergency Departments in Botswana

Pintye, Jillian; Ortblad, Katrina F; Mawandia, Shreshth; Bakae, Odirile; Tau, Lenna; Grande, Matias; Mogomotsi, Goabaone Pankie; Mmatli, Esther; Ngombo, Modise; Norman, Tebogo; Seckel, Laura; Ledikwe, Jenny H.

doi:10.1097/olq.0000000000001312

Cited by 3 publications

(4 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The proportion of newly identified PLHIV among participants completing testing was more than two-fold greater than the baseline population prevalence in the study setting (24). These data comport with prior studies in which HIV burdens among persons with injuries in Africa have been found to be greater than the prevalence in the corresponding populations (16), and that ED-based testing frequently identifies incident infections (18, 19, 37). As the current data pertaining to testing outcomes were limited, secondary to the low numbers of test offered, precise estimates on HIV burdens in the population studied are difficult to make and larger sampling frames are required.…”

Section: Discussionsupporting

confidence: 80%

Assessment of Standard HIV Testing Services Delivery to Injured Persons Seeking Emergency Care in Nairobi, Kenya: A Prospective Observational Study

Aluisio

Sugut

Kinuthia

et al. 2022

Preprint

View full text Add to dashboard Cite

Emergency departments (EDs) in Africa are contact points for key groups for HIV testing services (HTS) but understanding of ED-testing delivery is limited which may impeded program impacts. This study evaluated the offering and uptake of standard HTS among injured persons seeking ED care at Kenyatta National Hospital (KNH) in Nairobi, Kenya. An ED population of adult injured persons was prospectively enrolled (1 March - 25 May 2021) and followed through ED disposition. Participants requiring admission were followed through hospital discharge and willing participants were contacted at 28-days for follow up. Data on population characteristics and HTS were collected by personnel distinct from clinicians responsible for standard HTS. Descriptive analyses were performed and prevalence values with 95% confidence intervals (CI) were calculated for HIV parameters. The study enrolled 646 participants. The median age was 29 years with the majority male (87.8%). Most ED patients were discharged (58.9%). A prior HIV diagnosis was reported by 2.3% of participants and 52.7% reported their last testing as >6 months prior. Standard ED-HTS were offered to 49 or 8.6% of participants (95% CI: 5.8-9.9%), among which 89.8% accepted. For ED-tested participants 11.4% were newly diagnosed with HIV (95% CI: 5.0-24.0%). Among 243 participants admitted, testing was offered to 6.2% (95% CI: 3.9-9.9%), with 93.8% accepting. For admitted participants tested 13.3% (95% CI: 4.0-35.1%) were newly diagnosed (all distinct from ED cases). At 28-day follow up an additional 22 participants reported completing testing since ED visitation, with three newly diagnosed. During the full follow-up period the HIV prevalence in the population tested was 10.3% (95% CI: 5.3-19.0%); all being previously undiagnosed. Offering of standard HTS was infrequent, however, when offered, uptake and identification of new HIV diagnoses were high. These data suggest that opportunities exist to improve ED-HTS which could enhance identification of undiagnosed HIV.

show abstract

Section: Discussionsupporting

confidence: 80%

Assessment of Standard HIV Testing Services Delivery to Injured Persons Seeking Emergency Care in Nairobi, Kenya: A Prospective Observational Study

Aluisio

Sugut

Kinuthia

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…The proportion of newly identified PLHIV among participants completing testing was more than two-fold greater than the baseline population prevalence in the study setting [24]. These data comport with prior studies in which HIV burdens among persons with injuries in Africa have been found to be greater than the prevalence in the corresponding populations PLOS GLOBAL PUBLIC HEALTH [16], and that ED-based testing frequently identifies incident infections [18,19,37]. As the current data pertaining to testing outcomes were limited, secondary to the low numbers of test offered, precise estimates on HIV burdens in the population studied are difficult to make and larger sampling frames are required.…”

Section: Discussionsupporting

confidence: 72%

Assessment of standard HIV testing services delivery to injured persons seeking emergency care in Nairobi, Kenya: A prospective observational study

Aluisio

Sugut

Kinuthia

et al. 2022

PLOS Glob Public Health

View full text Add to dashboard Cite

Emergency departments (EDs) in Africa are contact points for key groups for HIV testing services (HTS) but understanding of ED-testing delivery is limited which may impeded program impacts. This study evaluated the offering and uptake of standard HTS among injured persons seeking ED care at Kenyatta National Hospital (KNH) in Nairobi, Kenya. An ED population of adult injured persons was prospectively enrolled (1 March—25 May 2021) and followed through ED disposition. Participants requiring admission were followed through hospital discharge and willing participants were contacted at 28-days for follow up. Data on population characteristics and HTS were collected by personnel distinct from clinicians responsible for standard HTS. Descriptive analyses were performed and prevalence values with 95% confidence intervals (CI) were calculated for HIV parameters. The study enrolled 646 participants. The median age was 29 years with the majority male (87.8%). Most ED patients were discharged (58.9%). A prior HIV diagnosis was reported by 2.3% of participants and 52.7% reported their last testing as >6 months prior. Standard ED-HTS were offered to 49 or 8.6% of participants (95% CI: 5.8–9.9%), among which 89.8% accepted. For ED-tested participants 11.4% were newly diagnosed with HIV (95% CI: 5.0–24.0%). Among 243 participants admitted, testing was offered to 6.2% (95% CI: 3.9–9.9%), with 93.8% accepting. For admitted participants tested 13.3% (95% CI: 4.0–35.1%) were newly diagnosed (all distinct from ED cases). At 28-day follow up an additional 22 participants reported completing testing since ED visitation, with three newly diagnosed. During the full follow-up period the HIV prevalence in the population tested was 10.3% (95% CI: 5.3–19.0%); all being previously undiagnosed. Offering of standard HTS was infrequent, however, when offered, uptake and identification of new HIV diagnoses were high. These data suggest that opportunities exist to improve ED-HTS which could enhance identification of undiagnosed HIV.

show abstract

“…Previously undiagnosed HIV was reported in 13 studies, with a pooled prevalence of 8.8% (95% CI: 4.3–17.2; eight studies) 43 , 45 , 47 , 48 , 50 , 51 , 84 , 89 among medical patients, and 5.0% (95% CI:3.0–8.1; five studies) 37 , 44 , 65 , 68 , 72 among emergency department patients ( Fig. 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…The pooled prevalence of HIV in medical wards was 36.4% (95% CI: 31.3–41.8; 25 studies) 39 , 40 , 43 , 45 , 47 – 49 , 51 , 52 , 55 , 56 , 60 , 61 , 64 , 69 – 71 , 79 , 81 , 84 – 87 , 89 higher than the prevalence in emergency departments (21.9%; 95% CI: 14.5–31.7; seven studies). 37 , 44 , 65 , 72 , 80 , 82 , 96 HIV infection was reported using laboratory or point-of-care diagnostics in 18 studies, 37 , 40 , 43 – 45 , 47 – 51 , 56 , 65 , 68 , 72 , 82 , 84 , 89 , 96 and by medical records or clinical history in the remaining studies ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Un miembro del personal de la Building Foundation for Development ayuda a preparar suministros para su entrega a instalaciones sanitarias y campos de desplazados en Al Jazirah (Sudán), que actualmente acoge a desplazados internos que huyen del conflicto en Jartum (Sudán).

Spencer,

Rylance,

Quint

et al. 2023

Bull World Health Org

View full text Add to dashboard Cite

Objective To estimate the prevalence of individual chronic conditions and multimorbidity among adults admitted to hospital in countries in sub–Saharan Africa. Methods We systematically searched MEDLINE®, Embase®, Global Index Medicus, Global Health and SciELO for publications reporting on patient cohorts recruited between 1 January 2010 and 12 May 2023. We included articles reporting prevalence of pre-specified chronic diseases within unselected acute care services (emergency departments or medical inpatient settings). No language restrictions were applied. We generated prevalence estimates using random-effects meta-analysis alongside 95% confidence intervals, 95% prediction intervals and I 2 statistics for heterogeneity. To explore associations with age, sex, country-level income status, geographical region and risk of bias, we conducted pre-specified meta-regression, sub-group and sensitivity analyses. Findings Of 6976 identified studies, 61 met the inclusion criteria, comprising data from 20 countries and 376 676 people. None directly reported multimorbidity, but instead reported prevalence for individual conditions. Among medical admissions, the highest prevalence was human immunodeficiency virus infection (36.4%; 95% CI: 31.3–41.8); hypertension (24.4%; 95% CI: 16.7–34.2); diabetes (11.9%; 95% CI: 9.9–14.3); heart failure (8.2%; 95% CI: 5.6–11.9); chronic kidney disease (7.7%; 95% CI: 3.9–14.7); and stroke (6.8%; 95% CI: 4.7–9.6). Conclusion Among patients seeking hospital care in sub-Saharan Africa, multimorbidity remains poorly described despite high burdens of individual chronic diseases. Prospective public health studies of multimorbidity burden are needed to generate integrated and context-specific health system interventions that act to maximize patient survival and well-being.

show abstract

Frequent Detection of Undiagnosed HIV Within Emergency Departments in Botswana

Cited by 3 publications

References 11 publications

Assessment of Standard HIV Testing Services Delivery to Injured Persons Seeking Emergency Care in Nairobi, Kenya: A Prospective Observational Study

Assessment of Standard HIV Testing Services Delivery to Injured Persons Seeking Emergency Care in Nairobi, Kenya: A Prospective Observational Study

Assessment of standard HIV testing services delivery to injured persons seeking emergency care in Nairobi, Kenya: A prospective observational study

Un miembro del personal de la Building Foundation for Development ayuda a preparar suministros para su entrega a instalaciones sanitarias y campos de desplazados en Al Jazirah (Sudán), que actualmente acoge a desplazados internos que huyen del conflicto en Jartum (Sudán).

Contact Info

Product

Resources

About