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Incidence of HIV-positive admission and inpatient mortality in Malawi [2012-2019]: a population cohort study

Burke, Rachael M, Henrion, Marc, Mallewa, Jane, Masamba, Leo, Kalua, Thokozani, Khundi, McEwan, Gupta-Wright, Ankur, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116, Masesa, Clemens, Corbett, Elizabeth L, Mwandumba, Henry ORCID: https://orcid.org/0000-0003-4470-3608 and MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613 (2021) 'Incidence of HIV-positive admission and inpatient mortality in Malawi [2012-2019]: a population cohort study'. AIDS, Vol 35, Issue 13, pp. 2191-2199.

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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- 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 living with HIV (PLHIV) (95%CI 10,068-11,568) were admitted during 2012-2019 compared to the counterfactual situation where admission rates stayed the same throughout this period. Absolute reductions were greatest for women aged 25-34 years (2,264 fewer HIV-positive admissions, 95%CI 2,002-2,526). In-hospital mortality for PLHIV was 23.5%, with no significant change over time in any age-sex group, and no association with ART use at admission.

CONCLUSIONS

Rates of admission for adult PLHIV decreased substantially, likely due to 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 PLHIV.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 26.5 Informatics. Health informatics
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WX Hospitals and Other Health Facilities > Hospital Administration > WX 173 Medical records
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.1097/QAD.0000000000003006
Depositing User: Julie Franco
Date Deposited: 09 Sep 2021 12:09
Last Modified: 15 Oct 2021 09:42
URI: https://archive.lstmed.ac.uk/id/eprint/18855

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