Abstract
Hospital admissions among people living with HIV (PLWH) in Botswana are high. Opportunistic infections (OIs) are responsible for most of these admissions. Although leading OIs causing these admissions have been identified in the region, their correlates are poorly understood. This study aimed to: 1) evaluate major OIs responsible for admissions among HIV patients at Princess Marina Hospital (PMH) in Botswana; 2) estimate the proportion and identify the most frequent admissions attributable to specific OIs; 3) characterize major correlates of admissions attributable to each specific OIs and identify populations most at risk as a base for effective policy and resource orientation. HIV infected patients were randomly selected from hospital record lists. Biomedical, sociodemographic and economic data were collected from the records and from face-to-face patient interviews and analyzed. Tuberculosis was the most important OI responsible for 234.6 per 1000 HIV admissions. Cryptococcal meningitis accounted for 162.0 per 1000 admissions. Patients with a CD4-cell count 350/μL and females. The risk of admission due to cryptococcal meningitis was also high among patients with low socioeconomic status (SES). Females were more at risk for Cryptosporidium, Bacterial pneumonia (BP), Pneumocystis Carinii Pneumonia (PCP), Herpes and candidiasis-specific admissions than male and, patients not on co-trimoxazole were more likely to be admitted than those on co-trimoxazole. Comprehensive implementation strategies to address OIs among PLWH are needed. To be effective, such strategies should address not only biomedical factors but should also focus on PLWH’s SES.
Highlights
The challenge of controlling and preventing opportunistic infections (OIs) among people living with HIV (PLWH) is brought about by numerous factors
Research works from Asia on the other hand identified oroesophageal candidiasis as the most common OI associated with almost 60% of hospital admissions [7]
Seven specific OIs were identified as major causes of admissions among HIV patients namely tuberculosis, cryptococcal meningitis, cryptosporidium, bacterial pneumonia, pneumococcal carinii pneumonia (PCP), herpes and candidiasis
Summary
The challenge of controlling and preventing opportunistic infections (OIs) among people living with HIV (PLWH) is brought about by numerous factors. Factors triggering hospital admission for OIs vary widely and may relate to: 1) patients’ underlying health conditions e.g. kidney failure, diabetes, hypertension; 2) geographical location; 3) living conditions e.g. poverty; 4) socio-demographic factors e.g. age and gender; and 5) behavioral characteristics e.g. alcoholism and substance abuse All these factors and their interactions need to be well studied and be understood to better comprehend circumstances that prompt OI hospital admissions in PLWH [1]. This setting had 47% of AIDS patients co-infected with cryptosporidium but only 7% of admissions due to PCP [7] These differences support regional variability of major OIs among PLWH, and point to the impact of environmental and general living conditions such as consumption of unsafe drinking water. Each region or country needs to know the factors associated with specific OIs causing admissions among her PLWH so as to inform interventions
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