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

Lottie Haachambwa, Nyakulira Kandiwo, Paul M. Zulu, David Rutagwera, Elvin Geng, Charles B. Holmes, Edford Sinkala, Cassidy W. Claassen, Michael J. Mugavero, Mwanza Wa Mwanza, Janet M. Turan, Michael J. Vinikoor

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article numberofz336
JournalOpen Forum Infectious Diseases
Volume6
Issue number10
DOIs
StatePublished - Sep 30 2019

Keywords

  • Afri2ca
  • HIV infection
  • care continuum
  • health systems
  • hospitalization

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

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