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Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019): a population cohort study
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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7611991/ https://www.ncbi.nlm.nih.gov/pubmed/34172671 http://dx.doi.org/10.1097/QAD.0000000000003006 |
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author | Burke, Rachael M Henrion, Marc Y R Mallewa, Jane Masamba, Leo Kalua, Thokozani Khundi, McEwan Gupta-Wright, Ankur Rylance, Jamie Gordon, Stephen B Masesa, Clemens Corbett, Elizabeth L Mwandumba, Henry C Macpherson, Peter |
author_facet | Burke, Rachael M Henrion, Marc Y R Mallewa, Jane Masamba, Leo Kalua, Thokozani Khundi, McEwan Gupta-Wright, Ankur Rylance, Jamie Gordon, Stephen B Masesa, Clemens Corbett, Elizabeth L Mwandumba, Henry C Macpherson, Peter |
author_sort | Burke, Rachael M |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7611991 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
record_format | MEDLINE/PubMed |
spelling | pubmed-76119912021-11-15 Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019): a population cohort study Burke, Rachael M Henrion, Marc Y R Mallewa, Jane Masamba, Leo Kalua, Thokozani Khundi, McEwan Gupta-Wright, Ankur Rylance, Jamie Gordon, Stephen B Masesa, Clemens Corbett, Elizabeth L Mwandumba, Henry C Macpherson, Peter AIDS Article 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. 2021-11-01 /pmc/articles/PMC7611991/ /pubmed/34172671 http://dx.doi.org/10.1097/QAD.0000000000003006 Text en https://creativecommons.org/licenses/by/4.0/This work is licensed under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/) International license. |
spellingShingle | Article Burke, Rachael M Henrion, Marc Y R Mallewa, Jane Masamba, Leo Kalua, Thokozani Khundi, McEwan Gupta-Wright, Ankur Rylance, Jamie Gordon, Stephen B Masesa, Clemens Corbett, Elizabeth L Mwandumba, Henry C Macpherson, Peter Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019): a population cohort study |
title | Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019): a population cohort study |
title_full | Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019): a population cohort study |
title_fullStr | Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019): a population cohort study |
title_full_unstemmed | Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019): a population cohort study |
title_short | Incidence of HIV-positive admission and inpatient mortality in Malawi (2012-2019): a population cohort study |
title_sort | incidence of hiv-positive admission and inpatient mortality in malawi (2012-2019): a population cohort study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7611991/ https://www.ncbi.nlm.nih.gov/pubmed/34172671 http://dx.doi.org/10.1097/QAD.0000000000003006 |
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