Unknown HIV Infection Prevalence and Associated Factors: Findings from A University Teaching Hospital in Tanzania

Abstract

Background: Early detection and effective treatment with antiretroviral drugs would help preserve/improve the immune system, ameliorate quality of life of persons with HIV/AIDS and prevent unintentional spread of the virus. To that end provider initiated HIV counseling and testing (PIHCT) is recommended as standard of care for all patients attending health facilities in HIV endemic countries. This study aimed at determining the prevalence and factors associated with unknown HIV infection among medical admissions at Muhimbili National Hospital (MNH) as an indicator of PIHTC practice in Dares salaam, Tanzania. Methods: Patients newly hospitalized into MNH medical wards with unknown HIV sero-status were recruited in this hospital based cross sectional study. Patients were interviewed, examined, counseled and tested for HIV. CD4+ T lymphocytes count was determined for HIV positive and patients were followed up to determine in hospital outcome and duration of stay. Results: Of the 505 patients with unknown HIV status, 30 (5.9%) tested positive for HIV and all of them had visited another health facility before being referred to MNH compared to 78.5% among those who tested negative (p=0.004). More than two thirds (66.7%) of the newly diagnosed HIV patients had advanced disease. But, history of chronic diarrhea and/or severe weight loss, severe wasting (Slim disease) common features of AIDS in the 1980s were not apparent despite the late clinical presentation. Patients presenting with fever, oral ulcers, oral candidiasis, altered mental status, generalized lymphadenopathy were more likely to be diagnosed with HIV infection. Age of ≥50 years had a negative correlation towards a new diagnosis of HIV infection. Conclusion: Over 85% of medical patients referred to MNH did not know their HIV status. Newly diagnosed HIV sero-positive patients did not present with AIDS defining illnesses although over two thirds of them had advanced disease and in hospital mortality was high.