Background: human immune virus and acquired immunodeficiency syndrome (HIV/AIDS) have been recognized in Botswana for the last three decades, however, combination anti-retroviral therapy (cART) was only introduced aft...Background: human immune virus and acquired immunodeficiency syndrome (HIV/AIDS) have been recognized in Botswana for the last three decades, however, combination anti-retroviral therapy (cART) was only introduced after 2000. Facility-based historical data of the burden of HIV/AIDS- related conditions pre-cART have so far not been analyzed. Objective: To analyze the burden of HIV-related admissions and HIV-related deaths, and identify the socio-demographic factors associated with HIV/AIDS deaths at Princess Marina Hospital (PMH) in the year 2000. Methods: A retrospective review of medical files was carried out between May and June 2014. Nine thousand seven hundred and forty-six (9746) records were analyzed for the year for 2000. Cases were identified as documented HIV/AIDS as per medical notes and/or documentation of any of the conditions listed in sections B20-B24 of the International Classification of Diseases (ICD 10 B20-B24). Outcomes were the percentages of HIV-related admissions and HIV-related deaths out of all admissions and deaths. The in-hospital case fatality rate (CFR) was also calculated. Log-binomial regression models were used to determine the most significant factors associated with HIV-related admission and death. Results: The percentages of HIV-related admissions and HIV-related deaths were 4.1% (403/9746) and 11.3% (80/707), respectively. The in-hospital HIV-CFR was 19.9% (80/403). Adjusted log-binomial models identified the most significant protective factors for HIV-related admission were female sex and cART use while age >15 years old was the most significant risk factor. The se of cART was significant protective factor for HIV-associated death while age older than 15 years was the most significant risk factor. Conclusion: There was a significant burden of HIV-related admissions and deaths in PMH before wide-scale cART use in Botswana. This study highlights the increased risk of hospital admission for HIV-positive patients and underlines the need for cART to prevent deaths. Further studies evaluating the impact of wide-scale cART roll out are needed.展开更多
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 identi...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 males were more likely to be admitted for both tuberculosis and cryptococcal meningitis compared to those 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.展开更多
文摘Background: human immune virus and acquired immunodeficiency syndrome (HIV/AIDS) have been recognized in Botswana for the last three decades, however, combination anti-retroviral therapy (cART) was only introduced after 2000. Facility-based historical data of the burden of HIV/AIDS- related conditions pre-cART have so far not been analyzed. Objective: To analyze the burden of HIV-related admissions and HIV-related deaths, and identify the socio-demographic factors associated with HIV/AIDS deaths at Princess Marina Hospital (PMH) in the year 2000. Methods: A retrospective review of medical files was carried out between May and June 2014. Nine thousand seven hundred and forty-six (9746) records were analyzed for the year for 2000. Cases were identified as documented HIV/AIDS as per medical notes and/or documentation of any of the conditions listed in sections B20-B24 of the International Classification of Diseases (ICD 10 B20-B24). Outcomes were the percentages of HIV-related admissions and HIV-related deaths out of all admissions and deaths. The in-hospital case fatality rate (CFR) was also calculated. Log-binomial regression models were used to determine the most significant factors associated with HIV-related admission and death. Results: The percentages of HIV-related admissions and HIV-related deaths were 4.1% (403/9746) and 11.3% (80/707), respectively. The in-hospital HIV-CFR was 19.9% (80/403). Adjusted log-binomial models identified the most significant protective factors for HIV-related admission were female sex and cART use while age >15 years old was the most significant risk factor. The se of cART was significant protective factor for HIV-associated death while age older than 15 years was the most significant risk factor. Conclusion: There was a significant burden of HIV-related admissions and deaths in PMH before wide-scale cART use in Botswana. This study highlights the increased risk of hospital admission for HIV-positive patients and underlines the need for cART to prevent deaths. Further studies evaluating the impact of wide-scale cART roll out are needed.
文摘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 males were more likely to be admitted for both tuberculosis and cryptococcal meningitis compared to those 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.
