Published in:
Open Access 01-12-2014 | Review
Inpatient mortality of HIV-infected adults in sub-Saharan Africa and possible interventions: a mixed methods review
Published in: BMC Health Services Research | Issue 1/2014
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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.