A comparative cross-sectional study of HIV positive and HIV negative medical admissions at Helderberg Hospital, Western Cape, South Africa

Berrisford, Alison (2015-07)

Thesis (MBChB, DipHIvMAN(SA))--Stellenbosch University, 2016


ENGLISH ABSTRACT: Introduction: The HIV epidemic has had a significant impact on the existing inpatient and outpatient health systems. The cost of inpatient care for HIV positive people has been shown to be greater than for HIV negative people and HIV infection has been associated with a higher inpatient mortality. These dynamics, in the face of an established antiretroviral program, have not been studied at district hospital level previously. Aim: The aim of this study was to describe the clinical patterns and cost implications in medical admissions at Helderberg Hospital, with particular reference to HIV infection and treatment. It includes a comparative analysis of HIV positive and HIV negative admissions. Methodology: This was a descriptive, quantitative study in the form of a cross-sectional survey. All medical admissions over defined 24 hour periods were recorded and data extracted from the medical records retrospectively. Results: 165 records were analysed. HIV prevalence was 19% and overall mortality 7%. 23(72%) of the 32 HIV positive patients had not yet accessed HIV services. The median CD4 count was 87cells/microl. The comparative analysis showed the HIV positive admissions to have a longer length of stay (5.9 days versus 3.6 days, p<0.01), higher laboratory costs (R717.28 versus R327.23, p<0.01) and higher pharmacy costs (R40.69 versus R11.72, p<0.01) than the HIV negative admissions. Outcomes for the HIV positive and negative patients were similar (p=0.64). Conclusion: Inpatient cost of care for HIV positive patients in this district hospital is more expensive than for HIV negative patients. Mortality rates in both groups are comparable. Antiretroviral therapy may be contributing to a decreased inpatient HIV prevalence and mortality rate. HIV positive patients are not accessing treatment in time to avoid morbidity requiring costly hospital admission. Further efforts are needed to expand outpatient HIV services, to explore the reasons why people with HIV are not accessing treatment timeously and to encourage rigorous treatment of HIV infected inpatients to ensure optimal outcomes.

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