Affiliation:
1. Kiruddu National Referral Hospital
2. Makerere University Joint AIDS Program
3. Infectious Diseases Institute
Abstract
Abstract
Background: Outcomes for Persons living with HIV (PLHIV) admitted to hospitals in Uganda are relatively unknown. We determined the prevalence of mortality and associated factors in PLHIV admitted at a tertiary-level public hospital in Uganda.
Methods: We used routinely collected data for PLHIV admitted at Kiruddu National Referral Hospital (KNRH) from March 2020 to March 2023 to perform a cross-sectional analysis for mortality (using proportions) and associated factors using a logistic regression model.
Results: Of the 5,827 PLHIV admitted, 3293 (56.51%) were female and the median age was 39 years (interquartile range [IQR] 31-49, range 12-98). CD4+ cell count was documented in 3,715 (63.75%) admitted PLHIV with a median count of 109 cells/µL (IQR 25-343, range 0-1,475). At admission, 3,710 (63.67%) were actively taking their antiretroviral therapy (ART), 1,144 (19.63%) had interrupted ART for more than three months and 973 (16.70%) were not on ART. Functional status impairment (measured using Eastern Cooperative Oncology Group [ECOG] score 3-4) was observed in 2,225 (38.18%) PLHIV.
Overall mortality was 26% (1,524) with a median time-to-death of 3 days (IQR 1-7, range 0-88). Factors associated with mortality included Function impairment odds ratio 7.23 (95%CI 6.31-8.29; undocumented CD4+ cell count 1.53 (95%CI 1.33-1.76, P<0.001); distance >20 Km from hospital 1.21 (95%CI 1.03-1.43, P=0.024); ART interruption 1.34 (95%CI 1.14-1.59; P<0.001); being male 1.16 (95%CI 1.02-1.32, P=0.029); severe malnutrition 1.81 (95%CI 1.51-2.16; P<0.001); COVID19 disease 1.74 (95%CI 1.24-2.43; P=0.001); liver disease 1.75 (95%CI 1.35-2.28; P<0.001); kidney disease 1.64 (95%CI 1.31-2.05; P<0.001); non-opportunistic infections 1.52 (95%CI 1.30-1.77, P<0.001); and anaemia 1.25 (95%CI 1.02-1.54, P=0.034).
Conclusion: One in every four admitted PLHIV died during hospitalization. Early identification and management of associated risk factors such as ART interruption, function impairment, baseline CD4+ tests and screening for non-communicable diseases, may avert poor hospital outcomes.
Publisher
Research Square Platform LLC
Reference67 articles.
1. UNAIDS, Global HIV. & AIDS statistics — Fact sheet | UNAIDS [Internet]. 2021 [cited 2021 Dec 31]. Available from: https://www.unaids.org/en/resources/fact-sheet.
2. UNAIDS. Uganda | UNAIDS [Internet]. 2021 [cited 2022 Jan 1]. Available from: https://www.unaids.org/en/regionscountries/countries/uganda.
3. Laher AE, Paruk F, Venter WDF, Ayeni OA, Richards GA. Predictors of in-hospital mortality among HIV-positive patients presenting with an acute illness to the emergency department. HIV Med [Internet]. 2021 Aug 1 [cited 2021 Dec 31];22(7):557–66. Available from: https://pubmed.ncbi.nlm.nih.gov/33792151/.
4. Kalyesubula Id R, Id TR, Andia-Biraro I, Alupo P, Kimuli I, Nabirye S et al. Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study. 2019; https://doi.org/10.1371/journal.pone.0216060.
5. Lakoh S, Jiba DF, Kanu JE, Poveda E, Salgado-Barreira A, Sahr F et al. Causes of hospitalization and predictors of HIV-associated mortality at the main referral hospital in Sierra Leone: a prospective study. BMC Public Health [Internet]. 2019 Oct 21 [cited 2021 Dec 31];19(1). Available from: https://pubmed.ncbi.nlm.nih.gov/31638941/.