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Haachambwa L, Kandiwo N, Zulu PM, et al. Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia. Open Forum Infect Dis. 2019;6(10):ofz336doi: 10.1093/ofid/ofz336.
Haachambwa, L., Kandiwo, N., Zulu, P. M., Rutagwera, D., Geng, E., Holmes, C. B., Sinkala, E., Claassen, C. W., Mugavero, M. J., Wa Mwanza, M., Turan, J. M., & Vinikoor, M. J. (2019). Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia. Open forum infectious diseases, 6(10), ofz336. https://doi.org/10.1093/ofid/ofz336
Haachambwa, Lottie, et al. "Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia." Open forum infectious diseases vol. 6,10 (2019): ofz336. doi: https://doi.org/10.1093/ofid/ofz336
Haachambwa L, Kandiwo N, Zulu PM, Rutagwera D, Geng E, Holmes CB, Sinkala E, Claassen CW, Mugavero MJ, Wa Mwanza M, Turan JM, Vinikoor MJ. Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia. Open Forum Infect Dis. 2019 Jul 16;6(10):ofz336. doi: 10.1093/ofid/ofz336. eCollection 2019 Oct. PMID: 31660330; PMCID: PMC6778319.
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Open Forum Infect Dis. 2019 Jul 16;6(10):ofz336. doi: 10.1093/ofid/ofz336. eCollection 2019 Oct.

Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia.

Open forum infectious diseases

Lottie Haachambwa, Nyakulira Kandiwo, Paul M Zulu, David Rutagwera, Elvin Geng, Charles B Holmes, Edford Sinkala, Cassidy W Claassen, Michael J Mugavero, Mwanza Wa Mwanza, Janet M Turan, Michael J Vinikoor

Affiliations

  1. Department of Medicine, University Teaching Hospital, Lusaka, Zambia.
  2. School of Medicine, University of Zambia, Lusaka, Zambia.
  3. School of Medicine, University of Maryland at Baltimore, Baltimore, Maryland.
  4. Zambia National Public Health Institute, Lusaka, Zambia.
  5. University Teaching Hospital HIV AIDS Programme, Lusaka, Zambia.
  6. Department of Medicine, University of California at San Francisco, San Francisco, California.
  7. Johns Hopkins University, Baltimore, Maryland.
  8. Center for Global Health and Quality, Georgetown University School of Medicine, Washington, District of Columbia.
  9. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
  10. Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
  11. School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.

PMID: 31660330 PMCID: PMC6778319 DOI: 10.1093/ofid/ofz336

Abstract

BACKGROUND: We characterized the extent of antiretroviral therapy (ART) experience and postdischarge mortality among hospitalized HIV-infected adults in Zambia.

METHODS: At a central hospital with an opt-out HIV testing program, we enrolled HIV-infected adults (18+ years) admitted to internal medicine using a population-based sampling frame. Critically ill patients were excluded. Participants underwent a questionnaire regarding their HIV care history and CD4 count and viral load (VL) testing. We followed participants to 3 months after discharge. We analyzed prior awareness of HIV-positive status, antiretroviral therapy (ART) use, and VL suppression (VS; <1000 copies/mL). Using Cox proportional hazards regression, we assessed risk factors for mortality.

RESULTS: Among 1283 adults, HIV status was available for 1132 (88.2%), and 762 (67.3%) were HIV-positive. In the 239 who enrolled, the median age was 36 years, 59.7% were women, and the median CD4 count was 183 cells/mm

CONCLUSIONS: Most HIV-related hospitalizations and deaths may now occur among ART-experienced vs -naïve individuals in Zambia. Development and evaluation of inpatient interventions are needed to mitigate the high risk of death in the postdischarge period.

© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Keywords: Africa; HIV infection; care continuum; health systems; hospitalization

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