Profile of presentation of HIV-positive patients to an emergency department in Johannesburg, South Africa

Laher, Abdullah E.; Venter, François; Richards, Guy A.; Paruk, Fathima

doi:10.4102/sajhivmed.v22i1.1177

Cited by 11 publications

(14 citation statements)

References 28 publications

(35 reference statements)

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“…Among those that were managed in the ED, 1308 were HIV-positive, however, 84 did not consent to study participation. Hence, the final study sample comprised 1224 patients [13][14][15]. The median (IQR) and mean (SD) LOS was 4.6 (2.6-8.2) days and 6.9 (8.2) days, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Predictors of prolonged hospital stay in HIV-positive patients presenting to the emergency department

et al. 2021

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Background Prolonged hospitalization places a significant burden on healthcare resources. Compared to the general population, hospital length of stay (LOS) is generally longer in HIV-positive patients. We identified predictors of prolonged hospital length of stay (LOS) in HIV-positive patients presenting to an emergency department (ED). Methods In this cross-sectional study, HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital adult ED were prospectively enrolled between 07 July 2017 and 18 October 2018. Data was subjected to univariate and multivariate logistic regression to determine parameters associated with a higher likelihood of prolonged hospital LOS, defined as ≥7 days. Results Among the 1224 participants that were enrolled, the median (IQR) LOS was 4.6 (2.6–8.2) days, while the mean (SD) LOS was 6.9 (8.2) days. On multivariate analysis of the data, hemoglobin <11 g/dL (OR 1.37, p = 0.032), Glasgow coma scale (GCS) <15 (OR 1.80, p = 0.001), creatinine >120 μmol/L (OR 1.85, p = 0.000), cryptococcal meningitis (OR 2.45, p = 0.015) and bacterial meningitis (OR 4.83, p = 0.002) were significantly associated with a higher likelihood of LOS ≥7 days, while bacterial pneumonia (OR 0.35, p = 0.000) and acute gastroenteritis (OR 0.40, p = 0.025) were significantly associated with a lower likelihood of LOS ≥7 days. Conclusion Various clinical and laboratory parameters are useful in predicting prolonged hospitalization among HIV-positive patients presenting to the ED. These parameters may be useful in guiding clinical decision making and directing the allocation of resources.

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Section: Resultsmentioning

confidence: 99%

“…Therefore, the aim of this study was to determine predictors of prolonged hospital stay (LOS �7 days) in HIV-positive patients presenting to the ED. Findings pertaining to other aspects of this study have been published separately [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Predictors of prolonged hospital stay in HIV-positive patients presenting to the emergency department

et al. 2021

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“…To our knowledge, this is the largest and most comprehensive single-centre study to have determined predictors of in-hospital mortality in consecutive HIV-positive patients in an ED setting. Findings pertaining to other aspects of this study have been published separately [21]. Although multiple studies have reported on the predictive value of various parameters in HIV-positive patients, most of these studies only reported on a few variables and were predominantly conducted in outpatient settings.…”

Section: Discussionmentioning

confidence: 99%

Predictors of in‐hospital mortality among HIV‐positive patients presenting with an acute illness to the emergency department

et al. 2021

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ObjectivesDespite better access to antiretroviral therapy (ART) over recent years, HIV remains a major global cause of mortality. The present study aimed to identify predictors of in-hospital mortality among HIV-positive patients presenting to an emergency department (ED). MethodsIn this cross-sectional study, HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital adult ED between 07 July 2017 and 18 October 2018 were prospectively enrolled. Data were compared between participants who survived to hospital discharge and those who died. The data were further subjected to univariate and multivariate logistic regression analyses to determine variables that were associated with in-hospital mortality. ResultsOf a total of 1224 participants, the in-hospital mortality was 13.6% (n = 166). On multivariate analysis, respiratory rate > 20 breaths/min [odds ratio (OR) = 1.90, P = 0.012], creatinine > 120 lmol/L (OR = 1.97, P = 0.006), oxygen saturation < 90% (OR = 2.09, P = 0.011), white cell count < 4.0 9 10 9 /L (OR = 2.09, P = 0.008), ART non-adherence or not yet on ART (OR = 2.39, P = 0.012), Glasgow Coma Scale < 15 (OR = 2.53, P = 0.000), albumin < 35 g/L (OR = 2.61, P = 0.002), lactate > 2 mmol/L (OR = 4.83, P = 0.000) and cryptococcal meningitis (OR = 6.78, P = 0.000) were significantly associated with in-hospital mortality. ConclusionsRoutine clinical and laboratory parameters are useful predictors of in-hospital mortality in HIVpositive patients presenting to the ED with an acute illness. These parameters may be of value in guiding clinical decision-making, directing the appropriate use of resources and influencing patient disposition, and may also be useful in developing an outcome prediction tool.

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“…Findings pertaining to other aspects of this study have been published separately. [17,18] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.…”

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Antiretroviral therapy non-adherence among HIV-positive patients presenting to an emergency department in Johannesburg, South Africa: Associations and reasons

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Sub-Saharan Africa has the highest prevalence of HIV in the world, with more than two-thirds of the global cases. [1] In 2019, South Africa (SA) had an estimated 7.5 million people living with HIV (PLWH), more than any other country in the world. The most current Joint United Nations Program on HIV/AIDS (UNAIDS) data report estimates that 92% of PLWH in SA are aware of their status, 70% are on antiretroviral therapy (ART), and 64% are virally suppressed. [2] The use of ART in PLWH has been associated with improvement in health-related quality of life and an overall reduction in the transmission of HIV, [3,4] whereas suboptimal adherence has been associated with a reduction in rates of viral suppression and an increase in rates of viral resistance, opportunistic infections, progression to AIDS and mortality. [5][6][7][8][9] In 2014, UNAIDS set a target for 90% of persons diagnosed with HIV to be on sustained ART by the year 2020. [10] Studies have shown that in order to achieve optimal viral suppression, ART adherence must be maintained above 90 -95%. [7,11,12] ART has been made available at SA public sector healthcare facilities since 2004, with significant strides over recent years in making ART more accessible to PLWH. [13] Currently there are ~5 million South Africans on ART, which is freely available at >3 500 healthcare facilities across the country. [2,14] Over the past decade, criteria for the initiation of ART in SA have gradually been relaxed in line with the World Health Organization recommendations, and as of September 2016, all HIV-positive patients, irrespective of their CD4 cell count or stage of disease, are considered eligible for ART initiation. [15] ART adherence rates have been measured by various methods including patient self-reporting, pill counts, pharmacy records, electronic medication monitoring devices, and laboratory evidence of virological or immunological failure. [11] In comparison with alternative measures of adherence, there is a tendency for patient self-reporting to overestimate ART adherence. [5] However, owing to its ease of use, this method remains widely used. [16] There is a lack of data pertaining to the rates of ART adherence and reasons for poor adherence among HIV-positive patients presenting to the emergency department (ED) with an acute illness. Because acutely ill HIV-positive patients frequently present with opportunistic infections and related pathology, we hypothesised that the rate of suboptimal adherence would be high in this group. Findings pertaining to other aspects of this study have been published separately. [17,18] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Profile of presentation of HIV-positive patients to an emergency department in Johannesburg, South Africa

Cited by 11 publications

References 28 publications

Predictors of prolonged hospital stay in HIV-positive patients presenting to the emergency department

Predictors of prolonged hospital stay in HIV-positive patients presenting to the emergency department

Predictors of in‐hospital mortality among HIV‐positive patients presenting with an acute illness to the emergency department

Antiretroviral therapy non-adherence among HIV-positive patients presenting to an emergency department in Johannesburg, South Africa: Associations and reasons

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