Abstract
BackgroundWhile most HIV care is provided on an outpatient basis, hospitals continue to treat serious HIV-related admissions, which is relatively resource-intensive and expensive. This study reports the primary reasons for HIV-related admission at a regional, urban hospital in Johannesburg, South Africa and estimates the associated lengths of stay and costs.Methods and FindingsA retrospective cohort study of adult, medical admissions was conducted. Each admission was assigned a reason for admission and an outcome. The length of stay was calculated for all patients (N = 1,041) and for HIV-positive patients (n = 469), actual utilization and associated costs were also estimated. Just under half were known to be HIV-positive admissions. Deaths and transfers were proportionately higher amongst HIV-positive admissions compared to HIV-negative and unknown. The three most common reasons for admission were tuberculosis and other mycobacterial infections (18%, n = 187), cardiovascular disorders (12%, n = 127) and bacterial infections (12%, n = 121). The study sample utilized a total of 7,733 bed days of those, 55% (4,259/7,733) were for HIV-positive patients. The average cost per admission amongst confirmed HIV-positive patients, which was an average of 9.3 days in length, was $1,783 (United States Dollars).ConclusionsEven in the era of large-scale antiretroviral treatment, inpatient facilities in South Africa shoulder a significant HIV burden. The majority of this burden is related to patients not on ART (298/469, 64%), and accounts for more than half of all inpatient resources. Reducing the costs of inpatient care is thus another important benefit of expanding access to ART, promoting earlier ART initiation, and achieving rates of ART retention and adherence.
Highlights
Widespread access to antiretroviral therapy (ART) is commonly assumed to have reduced the need for HIV-related hospital inpatient care, there is little published evidence confirming this in low- and middle-income countries
Even in the era of large-scale antiretroviral treatment, inpatient facilities in South Africa shoulder a significant HIV burden. The majority of this burden is related to patients not on ART (298/469, 64%), and accounts for more than half of all inpatient resources
Only a few published studies have examined the share of overall inpatient resource utilization attributable to HIV since the advent of public sector ART in 2004 [17, 19, 20], and none have estimated this in more recent years
Summary
Widespread access to antiretroviral therapy (ART) is commonly assumed to have reduced the need for HIV-related hospital inpatient care, there is little published evidence confirming this in low- and middle-income countries. While most HIV care is provided on an outpatient basis at public primary health clinics, hospitals continue to treat serious HIV-related admissions but the current extent and cost of this is unknown. Only a few published studies have examined the share of overall inpatient resource utilization attributable to HIV since the advent of public sector ART in 2004 [17, 19, 20], and none have estimated this in more recent years. While most HIV care is provided on an outpatient basis, hospitals continue to treat serious HIV-related admissions, which is relatively resource-intensive and expensive. This study reports the primary reasons for HIV-related admission at a regional, urban hospital in Johannesburg, South Africa and estimates the associated lengths of stay and costs
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