HIV-related mortality at a district hospital in Botswana

Abstract

We reviewed mortality data among medical inpatients at a tertiary hospital in Botswana to identify risk factors for adverse inpatient outcomes. This review was a prospective analysis of inpatient admissions. All medical admissions to male and female medical wards were recorded over a six-month period between 1 November 2011 and 30 April 2012. Data collected included patient demographics, HIV status (positive, negative, unknown), HIV testing history, HIV related treatment and serological history, admission and discharge diagnoses, and mortality status at final discharge or transfer. Of 972 patients admitted during the surveillance period, 427 (43.9%) were known to be HIV-positive on admission, 144 (14.8%) were known to be HIV-negative, and 401 (41.3%) had an unknown HIV status. Of those with unknown status, 131 (32.7%) were tested for HIV during admission and among these 35 (27.5%) were HIV-positive. Including patients with known mortality status following transfer, 172 (17.9%) patients died during the hospitalization. Death occurred in 105 (23%) of known HIV-positive patients, compared with 31 (13%) of known HIV-negative patients (p = 0.002, HR = 1.56 in adjusted analyses). Among HIV-positive patients who died, a low CD4 cell count (<200 cells/mm) was associated with death. Overall, patients who died had significantly more neurological and respiratory-related presenting complaints than patients who survived. In conclusion, we identified higher overall mortality among HIV-positive patients at a tertiary hospital in Botswana, and low rates of in-hospital HIV testing and antiretroviral therapy initiation. These data demonstrate that despite available antiretroviral therapy in the population for over a decade, HIV continues to add excess burden to the hospital system and adds to inpatient mortality in Botswana.

Inpatient mortality rates during an era of increased access to HIV testing and ART: A prospective observational study in Lilongwe, Malawi

“…The overall mortality rate was somewhat higher (19.4% versus 14.6%), but mortality among HIV-infected patients was similar (23.7% versus 24.2%) compared to prior to PITC [ 3 ]. Compared to studies within the country and region, our medical ward mortality rate was similar to that reported in South Africa (17%) [ 17 ], Botswana (23%) [ 18 ] and Blantyre, Malawi (22.7%) [ 15 ] within a period of PITC and early ART scale-up. The mortality rate among HIV positive patients in our study was lower than that found in a recent systematic review and meta-analysis of 31% within Africa [ 20 ] but was somewhat consistent with a mortality rate range of 24.2% to 44% within SSA reported in another study [ 16 ].…”

“…Similarly, the HIV prevalence rate was also comparable to a study done in Blantyre, Malawi within an era of PITC and ART scale-up where they found 4551/10191 (44.7%) positive patients [ 15 ]. However, the prevalence rate was lower compared to some countries within the region; South Africa (60.1%) [ 17 ] and Botswana (47.5%) [ 18 ]. The HIV prevalence rates among inpatients in Malawi has improved compared to the pre-ART era (70%) [ 19 ] highlighting the progress in the country’s ART program.…”

HIV‐associated morbidity and mortality in a setting of high ART coverage: prospective surveillance results from a district hospital in Botswana

“…We compared our results with those of similar surveillance conducted at SLH over a 6‐month period between November 2011 and April 2012 .During the current surveillance period, overall final HIV prevalence was lower (42.4% vs. 47.6% of admissions, p < 0.01) and the proportion of patients with unknown HIV status on admission declined (36.1 vs. 41.2% p < 0.01) as did the proportion of patients whose HIV status was unknown at discharge or death (10.7% vs. 27.7% p < 0.0001). Among HIV‐positive admissions in the current surveillance period, ART‐coverage was higher (72.2% vs. 56.2%, p < 0.0001), 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).…”

Profile of HIV Inpatients, Mortality Rate and Associated Factors in the Era of Antiretroviral Therapy at an Urban Hospital in Burkina Faso

“…Perry& al. reported a low CD4 cell count (<200 cells/mm 3 ) as a higher risk of death [25]. Such dissimilarities could be explained in our series by the low rate of achievement of CD4 count and the homogeneity of the targeted population who was mostly at an advanced WHO stage.…”