Causes of Admission and Survival After Discharge in Patients Attending a Specialized Hiv Clinic in Uganda.

Abstract

AbstractOBJECTIVE:To describe the causes of urgent care admission and survival after discharge in patients attending a specialized HIV clinic in Uganda.METHODS: We conducted a retrospective analysis of all urgent care admissions between August 2014 and July 2017. We captured diagnoses or major symptoms using MedDRA terminology and determined participants' characteristics associated with multiple admission using Poisson regression, determined the 1-year survival and predictors of mortality using Kaplan Meier methods and Cox proportional hazard models.RESULTS: During the 3-year period, 503 patients were admitted (71.4% were female and 87.9% were receiving antiretroviral therapy). Common causes of admission included bacterial pneumonia, urinary tract infection, anaemia, malaria, Kaposi's sarcoma, hypertension, and tuberculosis. Less common conditions included nervous system, metabolic, blood, and cardiac disorders. Female sex (aPR:1.48, 95%CI 1.00-2.17, p=0.05) and CD4 count <200 cells/ µL (aPR: 1.52, 95%CI 1.16 – 1.99, p= 0.02) were associated with multiple admissions. The probability of death after discharge was 14.9% (95%CI 11.5% to 19.0%) at 12 months. Male sex (aHR 2.06 95% CI 1.13 - 3.76, p=0.02), CD4 count <200 cells/ µL (aHR 3.85 95% CI 2.22 - 6.7, p<0.01), and anaemia (aHR 4.27 95% CI 1.64 - 11.15, p= <0.01) were predictors of mortality.CONCLUSION: Despite improved access to antiretroviral therapy, all-cause mortality remains high after discharge. Anaemia and low CD4 are significant predictors of mortality in the year after discharge. Large outpatient HIV centers in sub-Saharan Africa should be equipped to investigate various conditions, provide immediate care and link to hospital care as needed.