Introduction Little is known about outcomes after hospitalization for HIV-infected adults in sub-Saharan Africa. We determined 12-month, post-hospital mortality rates in HIV-infected vs. uninfected adults and predictors of mortality. Methods In this prospective cohort study, we enrolled adults admitted to the medical wards of a public hospital in northwestern Tanzania. We conducted standardized questionnaires, physical examinations, and basic laboratory analyses including HIV testing. Participants or proxies were called at one, three, six, and 12 months to determine outcomes. Predictors of in-hospital and post-hospital mortality were determined using logistic regression. Cox regression models were used to analyze mortality incidence and associated factors. To confirm our findings, we studied adults admitted to another government hospital. Results We enrolled 637 consecutive adult medical inpatients: 38/143 (26.6%) of the HIV-infected adults died in-hospital vs. 104/494 (21.1%) of the HIV-uninfected. Twelve-month outcomes were determined for 98/105 (93.3%) vs. 352/390 (90.3%) discharged adults, respectively. Post-hospital mortality was 53/105 (50.5%) for HIV-infected adults vs. 126/390 (32.3%) for HIV-uninfected (adjusted p=0.006). The 66/105 (62.9%) of HIV-infected who attended clinic within one month after discharge had significantly lower mortality than other HIV-infected adults (adjusted hazards ratio = 0.17 [0.07–0.39], p<0.001). Adults admitted to a nearby government hospital had similarly high rates of post-hospital mortality. Conclusions Post-hospital mortality is disturbingly high among HIV-infected adult inpatients in Tanzania. The post-hospital period may offer a window of opportunity to improve survival in this population. Interventions are urgently needed and should focus on increasing post-hospital linkage to primary HIV care.
Background Worldwide, people with hypertensive urgency experience high rates of hospitalization and death due to medication non-adherence. Interventions to improve medication adherence and health outcomes after hypertensive urgency are urgently needed. Methods This prospective cohort assessed the effect of a peer counselor intervention – named Rafiki mwenye msaada – on the 1-year incidence of hospitalization and/or death among adults with hypertensive urgency in Mwanza, Tanzania. We enrolled 50 patients who presented with hypertensive urgency to two hospitals in Mwanza, Tanzania. All 50 patients received a Rafiki mwenye msaada an individual-level, time-limited case management intervention. Rafiki mwenye msaada aims to empower adult patients with hypertensive urgency to manage their high blood pressure. It consists of 5 sessions delivered over 3 months by a peer counselor. Outcomes were compared to historical controls. Results Of the 50 patients (median age, 61 years), 34 (68%) were female, and 19 (38%) were overweight. In comparison to the historical controls, the intervention cohort had a significantly lower proportion of patients with a secondary level of education (22% vs. 35%) and health insurance (40% vs. 87%). Nonetheless, the 1-year cumulative incidence of hospitalization and/or death was 18% in the intervention cohort vs. 35% in the control cohort (adjusted Hazard Ratio, 0.48, 95% CI 0.24-0.97; P = 0.041). Compared to historical controls, intervention participants maintained higher rates of medication use and clinic attendance at both three and six months but not at 12 months. Of intervention participants who survived and remained in follow-up, >90% reported good medication adherence at all follow-up time points. Conclusion Our findings support the hypothesis that a peer counselor intervention may improve health outcomes among adults living with hypertensive urgency. A randomized clinical trial is needed to evaluate the intervention’s effectiveness.
Introduction-Little is known about outcomes after hospitalization for HIV-infected adults in sub-Saharan Africa. We determined 12-month, post-hospital mortality rates in HIV-infected vs. uninfected adults and predictors of mortality.Methods-In this prospective cohort study, we enrolled adults admitted to the medical wards of a public hospital in northwestern Tanzania. We conducted standardized questionnaires, physical examinations, and basic laboratory analyses including HIV testing. Participants or proxies were called at one, three, six, and 12 months to determine outcomes. Predictors of in-hospital and posthospital mortality were determined using logistic regression. Cox regression models were used to analyze mortality incidence and associated factors. To confirm our findings, we studied adults admitted to another government hospital.Results-We enrolled 637 consecutive adult medical inpatients: 38/143 (26.6%) of the HIVinfected adults died in-hospital vs. 104/494 (21.1%) of the HIV-uninfected. Twelve-month outcomes were determined for 98/105 (93.3%) vs. 352/390 (90.3%) discharged adults, respectively. Post-hospital mortality was 53/105 (50.5%) for HIV-infected adults vs. 126/390 (32.3%) for HIV-uninfected (adjusted p=0.006). The 66/105 (62.9%) of HIV-infected who attended clinic within one month after discharge had significantly lower mortality than other HIVinfected adults (adjusted hazards ratio = 0.17 [0.07-0.39], p<0.001). Adults admitted to a nearby government hospital had similarly high rates of post-hospital mortality.Conclusions-Post-hospital mortality is disturbingly high among HIV-infected adult inpatients in Tanzania. The post-hospital period may offer a window of opportunity to improve survival in
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