Advanced HIV disease management practices within inpatient medicine units at a referral hospital in Zambia: a retrospective chart review

AIDS Research and Therapy

Mundia Mwitumwa¹  Sombo Fwoloshi¹  Shabir Lakhi¹  Suilanji Sivile¹  Nyuma Mbewe¹  Lloyd Mulenga²  Cassidy W. Claassen³  Lottie Hachaambwa³  Michael J. Vinikoor⁴  Kristen Stafford⁵  Brianna Lindsay⁵  Mallika Yavatkar⁶ 

[1] Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia;Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia;Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA;Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA;Ministry of Health, Ndeke House, Lusaka, Zambia;Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia;Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA;Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA;Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia;University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA;Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA;Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA;University of Maryland School of Medicine, Baltimore, MD, USA;

关键词: Advanced HIV disease;    TB diagnostics;    Viral load monitoring;    Sub-Saharan Africa;   

DOI  :  10.1186/s12981-022-00433-8

来源: Springer

【 摘 要 】

BackgroundZambia recently achieved UNAIDS 90-90-90 treatment targets for HIV epidemic control; however, inpatient facilities continue to face a large burden of patients with advanced HIV disease and HIV-related mortality. Management of advanced HIV disease, following guidelines from outpatient settings, may be more difficult within complex inpatient settings. We evaluated adherence to HIV guidelines during hospitalization, including opportunistic infection (OI) screening, treatment, and prophylaxis.MethodsWe reviewed inpatient medical records of people living with HIV (PLHIV) admitted to the University Teaching Hospital in Lusaka, Zambia between December 1, 2018 and April 30, 2019. We collected data on patient demographics, antiretroviral therapy (ART), HIV biomarkers, and OI screening and treatment—including tuberculosis (TB), Cryptococcus, and OI prophylaxis with co-trimoxazole (CTX). Screening and treatment cascades were constructed based on the 2017 WHO Advanced HIV Guidelines.ResultsWe reviewed files from 200 charts of patients with advanced HIV disease; of these 92% (184/200) had been on ART previously; 58.1% (107/184) for more than 12 months. HIV viral load (VL) testing was uncommon but half of VL results were high. 39% (77/200) of patients had a documented CD4 count result. Of the 172 patients not on anti-TB treatment (ATT) on admission, TB diagnostic tests (either sputum Xpert MTB/RIF MTB/RIF or urine TB-LAM) were requested for 105 (61%) and resulted for 60 of the 105 (57%). Nine of the 14 patients (64%) with a positive lab result for TB died before results were available. Testing for Cryptococcosis was performed predominantly in patients with symptoms of meningitis. Urine TB-LAM testing was rarely performed.ConclusionsAt a referral hospital in Zambia, CD4 testing was inconsistent due to laboratory challenges and this reduced recognition of AHD and implementation of AHD guidelines. HIV programs can potentially reduce mortality and identify PLHIV with retention and adherence issues through strengthening inpatient activities, including reflex VL testing, TB-LAM and serum CrAg during hospitalization.

【 授权许可】

CC BY