Inpatient mortality of HIV-infected adults in sub-Saharan Africa and possible interventions: a mixed methods review

BMC Health Services Research

Daniel W Fitzgerald¹  Luke R Smart¹  Kedar Mate¹  Jennifer A Downs¹  Robert N Peck¹  Lauren E Webster¹  Bahati MK Wajanga² 

[1]Weill Cornell Medical College, New York, NY, USA

[2]Department of Internal Medicine, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania

关键词: Inpatients;    Health system;    Mortality;    Sub-Saharan Africa;    AIDS;    HIV;   

Others  :  1090228
DOI  :  10.1186/s12913-014-0627-9

 received in 2013-09-23, accepted in 2014-11-24,  发布年份 2014

【 摘 要 】

Background

Despite the increased availability of anti-retroviral therapy, in-hospital HIV mortality remains high in sub-Saharan Africa. Reports from Senegal, Malawi, and Tanzania show rates of in-hospital, HIV-related mortality ranging from 24.2% to 44%. This mixed methods review explored the potential causes of preventable in-hospital mortality associated with HIV infections in sub-Saharan Africa in the anti-retroviral era.

Results

Based on our experience as healthcare providers in Africa and a review of the literature we identified 5 health systems failures which may cause preventable in-hospital mortality, including: 1) late presentation of HIV cases, 2) low rates of in-hospital HIV testing, 3) poor laboratory capacity which limits CD4 T-cell testing and the diagnosis of opportunistic infections, 4) delay in initiation of anti-retroviral therapy in-hospital, and 5) problems associated with loss to follow-up upon discharge from hospital.

Conclusion

Our findings, together with the current available literature, should be used to develop practical interventions that can be implemented to reduce in-hospital mortality.

【 授权许可】

   
2014 Wajanga et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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