Incidence of HIV-Related Hospital Admission and Inpatient Mortality in Malawi (2012-2019): A Population Cohort Study

Burke, Rachael M; Henrion, Marc Y.R.; Mallewa, Jane; Masamba, Leo; Kalua, Thokozani; Khundi, McEwen; Gupta-Wright, Ankur; Rylance, Jamie; Gordon, Stephen B.; Masesa, Clemens; Corbett, EL; Mwandumba, Henry C.; MacPherson, Peter

doi:10.2139/ssrn.3751320

Cited by 3 publications

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“…Most missing files would presumably be of patients who died as death files are taken away from the wards expeditiously to perform death audits. However, TB and CM diagnoses and mortality estimates in this study align with previous work in Malawi [ 3 , 6 , 12 , 23 ].…”

Section: Discussionsupporting

confidence: 88%

“…A similar audit conducted eight years later at KCH reported the same mortality rate despite the marked expansion of ART nationally [ 3 , 6 ]. In Blantyre (southern Malawi), despite a reduction in population-based HIV mortality and hospitalization, inpatient mortality for PLHIV remained constant from 2012 to 2019 at the tertiary referral hospital (Queen Elizabeth Central Hospital) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Implementation of tuberculosis and cryptococcal meningitis rapid diagnostic tests amongst patients with advanced HIV at Kamuzu Central Hospital, Malawi, 2016–2017

et al. 2022

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Background Cryptococcal meningitis (CM) and tuberculosis (TB) remain leading causes of hospitalization and death amongst people living with HIV, particularly those with advanced HIV disease. In hospitalized patients, prompt diagnosis of these diseases may improve patient outcomes. The advanced HIV rapid diagnostic tests such as determine TB urine lipoarabinomannan lateral flow assay (urine LAM), urine X-pert MTB/RIF assay (urine X-pert), and serum/blood cryptococcal antigen test (serum CrAg) are recommended but frequently not available in many resource-limited settings. We describe our experience providing these tests in a routine hospital setting. Method From 1 August 2016 to 31 January 2017, a prospective cohort study to diagnose TB and Cryptococcal meningitis using point of care tests was conducted in the medical wards at Kamuzu Central Hospital, in Lilongwe, Malawi. The tests offered were PIMA CD4 cell count, serum CrAg, urine LAM, and urine X-pert. The testing was integrated into an existing HIV/TB treatment room on the wards and performed close to admission time. Patients were followed until discharge or death in the ward. Results We included 438 HIV-positive patients; 76% had a previously known HIV diagnosis (87% already on ART). We measured CD4 count in 365/438 (83%), serum CrAg in 301/438 (69%), urine LAM in 363/438 (83%), and urine X-pert in 292/438 (67%). The median CD4 count was 144 cells/ml (IQR 46–307). Serum CrAg positivity rate was 23 /301 (8%) and CM was confirmed by CSF Crag in 13/23 (56%). The majority of CM patients 9/13 (69%) started antifungal therapy within two days of diagnosis. Urine LAM and urine X-pert positivity rates were 81/363(22%) and (14/292 (5%) respectively. The positivity rate of urine LAM was higher in patients with low CD4 cell counts (< 100 cells/ml) and low BMI (< 18.5). Most patients with positive urine LAM started TB treatment on the same day. Despite the early diagnosis and treatment of TB and CM, the inpatient mortality was high; 30% and 25% respectively. Conclusion Although advanced HIV rapid diagnostic tests are recommended, one key challenge in implementation is the limited trained personnel administering the tests. Despite the effective use of the point of care tests in the clinical care of hospitalized TB and CM patients, mortality among these patients remained unacceptably high. Henceforth we need to train other cadres apart from nurses, clinicians, and laboratory technicians to conduct the tests. There is an urgent need to identify and modify other risks of death from TB and CM. Trial registration: Malawi National Health Science Research committee: Protocol # 1144. Registered 2 July 2014 and University Of North Carolina IRB #: UNCPM 21412, approved 13th October 2014.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Implementation of tuberculosis and cryptococcal meningitis rapid diagnostic tests amongst patients with advanced HIV at Kamuzu Central Hospital, Malawi, 2016–2017

et al. 2022

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“…This is most likely due to Malawi's active HIV program due to which the number of un-identified HIV positives is decreasing. Recent studies have shown that ART scaleup in Malawi has significantly reduced HIV positive hospital admissions [12]. On a national level the yield of HIV tests has also decreased and is found currently in 2020 at 3.0% (Department of HIV/AIDS, pers.…”

Section: Discussionmentioning

confidence: 99%

Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications

Heller

Damba

Kumwenda

et al. 2022

Annals of Global Health

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Setting: 100 bed medical ward in referral hospital, Lilongwe, Malawi.Objective: HIV positive patients admitted to hospital often have advanced HIV disease (AHD) and are at risk for mortality. WHO guidelines suggest a package of care for AHD; these are often not implemented, especially in inpatient settings. We describe an implementation model for AHD care, its outcomes in routine care and provide cost estimates.Design: An "AHD care room" was established staffed by HIV counselor, nurse, and clinical officer allowing Provider Initiated Testing and Counseling, diagnostic testing for AHD and ensuring availability of HIV and TB drugs for rapid treatment initiation. Results:In the observation period from January to December 2020, a total of 1549 medical inpatients were tested for HIV (coverage 77.1%); 69 tested positive (yield 4.5%). The total proportion of HIV positive was 32.3% (638 already on ART and 69 newly diagnosed). CD4+ testing was done in 460 medical inpatients (65.1%); 245 (53.2%) were below 200 cells/ml and thus met definition of AHD. A total of 238 received S-CrAg tests; 39 (16.3%) were positive; 62 (28.3%

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“…Malaria is endemic in the region, and the current estimated HIV prevalence in Malawi is 9.2% 13 . Recently the HIV infection prevalence amongst adult medical inpatients admitted to QECH has been recorded at approximately 40% 14 .…”

Section: Study Sitementioning

confidence: 99%

Incidence of invasive non-typhoidal Salmonella in Blantyre, Malawi between January 2011-December 2019

et al. 2022

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Background: The Malawi-Liverpool Wellcome Trust Clinical Research Programme (MLW) has undertaken sentinel surveillance of bloodstream infection and meningitis at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi for 20 years. Previously, three epidemics of Salmonella bloodstream infection have been identified. Here we provide updated surveillance data on invasive non-typhoidal Salmonella disease from 2011 – 2019. Methods: Surveillance data describing trends in invasive non-typhoidal Salmonella disease and associated antimicrobial susceptibility profiles are presented for the period January 2011 – December 2019. Results: Between January 2011-December 2019, 128,588 blood cultures and 40,769 cerebrospinal fluid cultures were processed at MLW. Overall, 1.00% of these were positive for S. Typhimurium, 0.10% for S. Enteritidis, and 0.05% positive for other Salmonella species. Estimated minimum incidence of invasive non-typhoidal Salmonella (iNTS) disease decreased from 21/100,000 per year in 2011 to 7/100,000 per year in 2019. Over this period, 26 confirmed cases of Salmonella meningitis were recorded (88.5% S. Typhimurium). Between 2011-2019 there was a substantial decrease in proportion of S. Typhimurium (78.5% to 27.7%) and S. Enteritidis (31.8% in 2011 to 0%) that were multidrug-resistant. Resistance to fluoroquinolones and third-generation generation cephalosporins (3GC) remained uncommon, however 3GC increased amongst Salmonella spp. and S. Typhimurium in the latter part of the period. Conclusions: The total number of iNTS bloodstream infections decreased between 2011-2019. Although the number multidrug resistance (MDR) S. Typhimurium and S. Enteritidis isolates has fallen, the number of MDR isolates of other Salmonella spp. has increased, including 3GC isolates.

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Incidence of HIV-Related Hospital Admission and Inpatient Mortality in Malawi (2012-2019): A Population Cohort Study

Cited by 3 publications

References 0 publications

Implementation of tuberculosis and cryptococcal meningitis rapid diagnostic tests amongst patients with advanced HIV at Kamuzu Central Hospital, Malawi, 2016–2017

Implementation of tuberculosis and cryptococcal meningitis rapid diagnostic tests amongst patients with advanced HIV at Kamuzu Central Hospital, Malawi, 2016–2017

Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications

Incidence of invasive non-typhoidal Salmonella in Blantyre, Malawi between January 2011-December 2019

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