Inpatient mortality of HIV-infected adults in sub-Saharan Africa and possible interventions: a mixed methods review.

Bahati Mk Wajanga,Lauren E Webster,Kedar Mate,Daniel W Fitzgerald,Robert N Peck,Jennifer A Downs,Luke R Smart

doi:10.1186/s12913-014-0627-9

Abstract

BackgroundDespite the increased availability of anti-retroviral therapy, in-hospital HIV mortality remains high in sub-Saharan Africa. Reports from Senegal, Malawi, and Tanzania show rates of in-hospital, HIV-related mortality ranging from 24.2% to 44%. This mixed methods review explored the potential causes of preventable in-hospital mortality associated with HIV infections in sub-Saharan Africa in the anti-retroviral era.ResultsBased on our experience as healthcare providers in Africa and a review of the literature we identified 5 health systems failures which may cause preventable in-hospital mortality, including: 1) late presentation of HIV cases, 2) low rates of in-hospital HIV testing, 3) poor laboratory capacity which limits CD4 T-cell testing and the diagnosis of opportunistic infections, 4) delay in initiation of anti-retroviral therapy in-hospital, and 5) problems associated with loss to follow-up upon discharge from hospital.ConclusionOur findings, together with the current available literature, should be used to develop practical interventions that can be implemented to reduce in-hospital mortality.

Highlights

The aim of the literature review is to explore the potential causes of preventable in-hospital mortality associated with Human immunodeficiency virus (HIV) infections in sub-Saharan Africa in the antiretroviral era, and to discuss possible health systems improvements that may reduce this mortality
We recognize that a substantial number of HIV-related deaths in sub-Saharan Africa occur among community dwelling individuals who do not have access to care and medications
This study demonstrated that the health system failure resulting in a 3-month delay of article retroviral treatment (ART) led to a substantial number of deaths in patients with severe immune suppression [60]

Summary

Results

Based on our experience as healthcare providers in Africa and a review of the literature we identified 5 health systems failures which may cause preventable in-hospital mortality, including: 1) late presentation of HIV cases, 2) low rates of in-hospital HIV testing, 3) poor laboratory capacity which limits CD4 T-cell testing and the diagnosis of opportunistic infections, 4) delay in initiation of anti-retroviral therapy in-hospital, and 5) problems associated with loss to follow-up upon discharge from hospital

Introduction

Conclusions

15. UNAIDS

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45. Cohen GM