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PLoS One. 2018 Feb 7;13(2):e0191944. doi: 10.1371/journal.pone.0191944. eCollection 2018.

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

Author information

1
University of North Carolina Project, Lilongwe, Malawi.
2
University of North Carolina, Chapel Hill, North Carolina, United States of America.
3
University of Washington, Seattle, Washington, United States of America.
4
Kamuzu Central Hospital, Lilongwe, Malawi.
5
Lighthouse Trust, Lilongwe, Malawi.

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.

PMID:
29415015
PMCID:
PMC5802850
DOI:
10.1371/journal.pone.0191944
[Indexed for MEDLINE]
Free PMC Article

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