Abstract
IntroductionDetermining HIV serostatus is crucial for linking HIV-infected patients to appropriate care, which might reduce their risk of subsequent morbidity and mortality. A recent South African study demonstrated a potentially harmful association between an unknown HIV serostatus and rehospitalisation. The impact of an unknown HIV status on inpatient mortality has not yet been established in that setting, which formed the impetus for the current study.MethodsThis was an unmatched case-control analysis of adult patient data collected as part of a demographic survey at the Hlabisa Hospital, South Africa between October 2009 and February 2014. Cases were defined as patients who suffered inpatient mortality, while controls were patients who did not suffer inpatient mortality. A sample size of 92 cases and 276 controls was used in this study. Patient data related to age, gender, distance between referral clinic and the hospital, HIV serostatus (HIV-negative, HIV-positive or an unknown HIV serostatus) and comorbidity were analysed using recommended methods for unmatched case-control studies.ResultsWhen potential confounders were accounted for, we found an unknown HIV serostatus to be associated with an almost 8-fold increase in the odds of inpatient mortality when compared with patients who were known HIV-negative (Odds Ratio: 7.64, 95% Confidence Interval: 1.11-52.33, p = 0.038).ConclusionAn unknown HIV serostatus was independently associated with a higher odds of inpatient mortality. This finding highlights the potential benefit of adopting an “opt-out” approach to HIV counseling and testing. Further research on this topic is required.
Highlights
Determining HIV serostatus is crucial for linking HIV-infected patients to appropriate care, which might reduce their risk of subsequent morbidity and mortality
When potential confounders were accounted for, we found an unknown HIV serostatus to be associated with an almost 8-fold increase in the odds of inpatient mortality when compared with patients who were known HIV-negative
We found that when compared with a HIV-negative serostatus, an unknown HIV serostatus was associated with an almost 8-fold increase in the odds of suffering inpatient mortality in our setting
Summary
Determining HIV serostatus is crucial for linking HIV-infected patients to appropriate care, which might reduce their risk of subsequent morbidity and mortality. Large clinical studies investigating patient outcomes (including mortality) are scarce in resource-limited settings due to logistical challenges in creating and maintaining patient registries at healthcare facilities [5] This has since improved with the establishment of surveillance mechanisms, such as the publically-available Africa Centre Demographic Information System (ACDIS), which collected inpatient data from a hospital located in a South African setting with a high prevalence of HIV infection [6]. An understanding of any potential association between an unknown HIV serostatus and inpatient mortality might have important implications on initiatives aimed at improving the uptake of HIV counseling and testing in this setting, as well as improving subsequent linkage to care in patients with previously undiagnosed HIV infection This formed the impetus for the current study
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