Twelve-month outcomes of patients admitted to the acute general medical service at Groote Schuur Hospital

Stuart-Clark, H; Vorajee, N; Zuma, Sibusiso Memory; Niekerk, Lindi van; Burch, Vanessa; Raubenheimer, Peter; Peter, Jonny

doi:10.7196/samj.5615

Cited by 19 publications

(27 citation statements)

References 10 publications

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Section: Participantsmentioning

confidence: 99%

“…11,79 Irrespective of their final diagnosis, people identified as having symptoms of TB have a high probability of being HIV-infected, 22,80 being unaware of their HIV status, being eligible for ART 80 and having a high risk of death if their HIV is not promptly diagnosed and treated. [80][81][82][83] Indeed, in settings with generalised HIV epidemics, the NNTS to identify one patient with undiagnosed HIV is far lower than the NNTS to identify one patient with undiagnosed TB.More completely integrated TB-HIV interventions include HIV treatment-as-prevention (TasP) strategies providing home-based HTC with TB screening and immediate ART and IPT for HIV-positive individuals, 84 and combined TB and household-based HIV and TB prevention. 6 ART for TasP has extremely high potential as a TB control strategy, with declining national and regional TB incidence apparent already just from routine ART scaleup.…”

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confidence: 99%

See 1 more Smart Citation

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Corbett

MacPherson²

2013

int j tuberc lung dis

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SUMMARYTwenty years of sky-high tuberculosis (TB) incidence rates and high TB mortality in high human immunodeficiency virus (HIV) prevalence countries have so far not been matched by the same magnitude or breadth of responses as seen in malaria or HIV programmes. Instead, recommendations have been narrowly focused on people presenting to health facilities for investigation of TB symptoms, or for HIV testing and care. However, despite the recent major investment and scale-up of TB and HIV services, undiagnosed TB remains highly prevalent at community level, implying that diagnosis of TB remains slow and incomplete. This maintains high transmission rates and exposes people living with HIV to high rates of morbidity and mortality.More intensive use of TB screening, with broader definitions of target populations, expanded indications for screening both inside and outside of health facilities, and appropriate selection of new diagnostic tools, offers the prospect of rapidly improving population-level control of TB. Diagnostic accuracy of suitable (high throughput) algorithms remains the major barrier to realising this goal.In the present study, we review the evidence available to guide expanded TB screening in HIVprevalent settings, ideally through combined TB-HIV interventions that provide screening for both TB and HIV, and maximise entry to HIV and TB care and prevention. Ideally, we would systematically test, treat and prevent TB and HIV comprehensively, offering both TB and HIV screening to all health facility attendees, TB households and all adults in the highest risk communities. However, we are still held back by inadequate diagnostics, financing and paucity of population-impact data. Relevant contemporary research showing the high need for potential gains, and pitfalls from expanded and intensified TB screening in high HIV prevalence settings are discussed in this review. In high human immunodeficiency virus (HIV) prevalence settings, population-level tuberculosis (TB) incidence increased in parallel with adult HIV prevalence in the 1990s and remains extremely high, with over 1% of adults diagnosed with TB each year in many Southern African towns. 1 Outbreaks of multi-and extensively drug-resistant TB (XDR-TB) have been generated in HIV care clinics, and then spread into general communities. 2,3 Autopsy studies show that TB is the single biggest killer of people living with HIV (PLHIV), being the cause in 32% to 45% of HIV-related deaths 4 and with a high proportion of fatal cases undiagnosed in life. 4,5 Of the estimated 430 000 TB-related deaths among PLHIV during 2011, 79% were in Africa. These stark facts demonstrate the urgent need to strengthen TB prevention and care services using all available approaches, including more ambitious TB screening strategies.TB screening is the first step in both anti-tuberculosis treatment and TB prevention pathways, and has an integral place in routine HIV care and infection control. Key potential entry points for TB screening are illustrated in Figure 1. TB screening c...

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Section: Participantsmentioning

confidence: 99%

mentioning

confidence: 99%

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Corbett

MacPherson²

2013

int j tuberc lung dis

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“…1,2 Therefore, hospitals may offer an important window of opportunity to identify these conditions, initiate treatment and link to primary care. 3,4 Unfortunately, little is known about post-hospital outcomes for African adults.…”

Section: Introductionmentioning

confidence: 99%

Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study

Peck

Wang

Mtui

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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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.

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“…The main cohort of patients seen in the Emergency Unit are those with major strokes, and the median length of stay is 25 hours. The success of this project, together with the research findings from StuartClark et al, [9] which demonstrated a 42% 12-month mortality rate among medical patients at GSH, and research of Van Niekerk and Raubenheimer, [10] who identified a high proportion of patients expected to benefit from end-of-life and palliative care, were used to motivate for a permanent hospital palliative care team for medical patients with acute conditions admitted to GSH. Van Niekerk and Raubenheimer [10] reported that 20.3% of patients in general medical wards had life-limiting illnesses, potentially requiring palliative care.…”

Section: Development Of Palliative Care In South Africamentioning

confidence: 99%

“…The Abundant Life patients were shown to have fewer admissions, fewer days in hospital, higher rates of supported home deaths and lower hospital costs than the control group. [9] The referrals have grown from 200 patients in the first 2 years and 70 active patients at the end of 2011, to >600 referrals for 2016 and 250 active patients. The service has extended from the medical wards into the surgical wards, referral criteria have been broadened and a part-time palliative care nurse has been appointed to a provincial position at Victoria Hospital.…”

Section: Development Of Palliative Care In South Africamentioning

confidence: 99%

The development of hospital-based palliative care services in public hospitals in the Western Cape, South Africa

et al. 2018

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Author contributions. RK, LG and PR conceived the article. LG wrote the introduction and development sections. RK, PR and TC composed the section on GSH.LG, HG and JS were responsible for the partnership section.RK, LG, PR and CC wrote on identifying patients. LG and RK compiled the community resources section. All co-authors reviewed the article, added comments and made editorial changes, which were included by LG.Funding. None. Conflicts of interest.None.

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Twelve-month outcomes of patients admitted to the acute general medical service at Groote Schuur Hospital

Cited by 19 publications

References 10 publications

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study

The development of hospital-based palliative care services in public hospitals in the Western Cape, South Africa

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