‘It is not fashionable to suffer nowadays’: Community motivations to repeatedly participate in outreach HIV testing indicate UHC potential in Tanzania

Objective This study examined people’s motivations for (repeatedly) utilizing HIV testing services during community-based testing events in urban and rural Shinyanga, Tanzania and potential implications for Universal Health Coverage (UHC). Methods As part of a broader multidisciplinary study on the implementation of a HIV Test and Treat model in Shinyanga Region, Tanzania, this ethnographic study focused on community-based testing campaigns organised by the implementing partner. Between April 2018 and December 2019, we conducted structured observations (24), short questionnaires (42) and in-depth interviews with HIV-positive (23) and HIV-negative clients (8). Observations focused on motivations for (re-)testing, and the counselling and testing process. Thematic analysis based on inductive and deductive coding was completed using NVivo software. Results Regular HIV testing was encouraged by counsellors. Most participants in testing campaigns were HIV-negative; 51.1% had tested more than once over their lifetimes. Testing campaigns provided an accessible way to learn one’s HIV status. Motivations for repeat testing included: monitoring personal health to achieve (temporary) reassurance, having low levels of trust toward sexual partners, feeling at risk, seeking proof of (ill)-health, and acting responsibly. Repeat testers also associated testing with a desire to start treatment early to preserve a healthy-looking body, should they prove HIV positive. Conclusions Community-based testing campaigns serve three valuable functions related to HIV prevention and treatment: 1) enable community members to check their HIV status regularly as part of a personalized prevention strategy that reinforces responsible behaviour; 2) identify recently sero-converted clients who would not otherwise be targeted; and 3) engage community with general prevention and care messaging and services. This model could be expanded to include routine management of other (chronic) diseases and provide an entry for scaling up UHC.

Download Full-text

Repeat HIV testing of individuals with discrepant HIV self-test results in Central Uganda

AIDS Research and Therapy ◽

10.1186/s12981-019-0243-1 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 1

Author(s):

Rose Kisa ◽

Joseph K. B. Matovu ◽

Esther Buregyeya ◽

William Musoke ◽

Caroline J. Vrana-Diaz ◽

...

Keyword(s):

Hiv Testing ◽

Hiv Positive ◽

Test Results ◽

Hiv Status ◽

Weak Band ◽

Rapid Hiv Testing ◽

Hiv Test ◽

Self Test ◽

Dna Pcr ◽

Hiv Negative

Abstract Background According to the user instructions from the manufacturer of OraQuick HIV self-test (HIVST) kits, individuals whose kits show one red band should be considered to be HIV-negative, no matter how weak the band is. However, recent reports show potential for a second false weak band after storage, thereby creating confusion in the interpretation of results. In this study, we re-tested individuals whose results were initially non-reactive but changed to weak reactive results to determine their true HIV status. Methods This study was nested within a large, cluster-randomized HIVST trial implemented among pregnant women attending antenatal care and their male partners in central Uganda between July 2016 and February 2017. Ninety-five initially HIV-negative respondents were enrolled into this study, including 52 whose kits developed a second weak band while in storage and 43 whose kits were interpreted as HIV-positive by interviewers at the next follow-up interview. Respondents were invited to return for repeat HIVST which was performed under the observation of a trained nurse counsellor. After HIVST, respondents underwent blood-based rapid HIV testing as per the national HIV testing algorithm (Determine (Abbot Laboratories), STAT-PAK (Chembio Diagnostic Systems Inc.) and Unigold (Trinity Biotech plc.) and dry blood spots were obtained for DNA/PCR testing. DNA/PCR was considered as the gold-standard HIV testing method. Results After repeat HIVST, 90 (94.7%) tested HIV-negative; 2 (2.1%) tested HIV-positive; and 3 (3.2%) had missing HIV test results. When respondents were subjected to blood-based rapid HIV testing, 97.9% (93/95) tested HIV-negative while 2.1% (2/95) tested HIV-positive. Finally, when the respondents were subjected to DNA/PCR, 99% (94/95) tested HIV-negative while 1.1% (1/95) tested HIV-positive. Conclusions Nearly all initially HIV-negative individuals whose HIVST kits developed a second weak band while in storage or were interpreted as HIV-positive by interviewers were found to be HIV-negative after confirmatory DNA/PCR HIV testing. These findings suggest a need for HIV-negative individuals whose HIVST results change to false positive while under storage or under other sub-optimal conditions to be provided with an option for repeat testing to determine their true HIV status.

Download Full-text

Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053195 ◽

2017 ◽

Vol 94 (3) ◽

pp. 194-199 ◽

Cited By ~ 4

Author(s):

James Blain Johnston ◽

Joss N Reimer ◽

John L Wylie ◽

Jared Bullard

Keyword(s):

Viral Load ◽

Hiv Testing ◽

Clinical Outcomes ◽

Point Of Care ◽

Age Groups ◽

Linkage To Care ◽

Hiv Positive ◽

Hiv Status ◽

Viral Load Suppression ◽

Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

Download Full-text

HIV post-test practices: an online survey examining perceived delivery of HIV test results, post-test discussion and referral in healthcare settings across the WHO European Region

Sexual Health ◽

10.1071/sh15186 ◽

2016 ◽

Vol 13 (3) ◽

pp. 205 ◽

Cited By ~ 2

Author(s):

Stephen Bell ◽

Jordi Casabona ◽

Nino Tsereteli ◽

Dorthe Raben ◽

John de Wit

Keyword(s):

Hiv Testing ◽

Positive Test ◽

European Region ◽

Hiv Positive ◽

Test Results ◽

Negative Test ◽

Hiv Test ◽

Post Test ◽

Test Result ◽

Hiv Negative

Background The aim of this study was to assess perceptions of health professionals involved in HIV testing policy and practice in national settings across the WHO European Region regarding the delivery of HIV test results, post-test discussion and referral to specialist HIV services as recommended in authoritative guidelines. Methods: An online self-report survey was completed by a convenience sample of 338 respondents (response rate 34.1%) from 55 countries. Respondents worked with non-government organisations (49.4%), health services (32.8%), non-health service government agencies (6.2%) or other organisations (11.5%; e.g. prisons, education and research, international development). Results: Experts’ perceptions indicate that delivery of HIV-positive test results and related post-test discussion in their country generally corresponded to recommendations. However, results pointed to a significant gap perceived by experts between recommendations and the practice of delivering HIV-negative test results. Fewer respondents thought that suitable time is taken to deliver a negative HIV-test result (54.1%) than a positive result (73.1%). Also, fewer respondents thought there was a procedure for referral to specialist treatment, care and support services for people receiving a HIV-negative test result (34.9%) than for people receiving an HIV-positive test result (86.2%). Experts also reported low perceived use of communication technologies (i.e. telephone, email, text messaging, a secure website) for delivering HIV test results. Conclusions: This expert survey offers new insight into perceived HIV post-test practices in almost all national settings across the WHO European Region. The findings provide valuable guidance for future HIV testing guidelines for the WHO European Region.

Download Full-text

Rates and Correlates of HIV Incidence in Namibia’s Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study

JMIR Public Health and Surveillance ◽

10.2196/17107 ◽

2020 ◽

Vol 6 (2) ◽

pp. e17107

Author(s):

Andrew D Maher ◽

Tuli Nakanyala ◽

Nicholus Mutenda ◽

Karen M Banda ◽

Dimitri Prybylski ◽

...

Keyword(s):

Hiv Testing ◽

Rural Areas ◽

Sub Saharan Africa ◽

Hiv Incidence ◽

Community Based ◽

Home Based ◽

Hiv Test ◽

Hiv Acquisition ◽

Hiv Negative

Background Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia’s Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV. Objective The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot. Methods Following the program’s initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion. Results Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment. Conclusions Nearly three decades into Namibia’s generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.

Download Full-text

Rates and Correlates of HIV Incidence in Namibia’s Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study (Preprint)

10.2196/preprints.17107 ◽

2019 ◽

Author(s):

Andrew D Maher ◽

Tuli Nakanyala ◽

Nicholus Mutenda ◽

Karen M Banda ◽

Dimitri Prybylski ◽

...

Keyword(s):

Hiv Testing ◽

Rural Areas ◽

Sub Saharan Africa ◽

Hiv Incidence ◽

Community Based ◽

Home Based ◽

Hiv Test ◽

Hiv Acquisition ◽

Hiv Negative

BACKGROUND Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia’s Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV. OBJECTIVE The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot. METHODS Following the program’s initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion. RESULTS Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment. CONCLUSIONS Nearly three decades into Namibia’s generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.

Download Full-text

Using routine programmatic data to measure HIV incidence among pregnant women in Botswana

10.21203/rs.3.rs-19601/v1 ◽

2020 ◽

Author(s):

Katrina Frances Ortblad ◽

Sheshth Mawandia ◽

Odirile Bakae ◽

Lenna Tau ◽

Matias Grande ◽

...

Keyword(s):

Pregnant Women ◽

Hiv Testing ◽

Real World ◽

Sub Saharan Africa ◽

Hiv Positive ◽

Surveillance Systems ◽

Hiv Incidence ◽

Art Initiation ◽

Hiv Test ◽

Hiv Negative

Abstract Introduction: Pregnant women in sub-Saharan Africa have high risk of HIV acquisition, yet approaches for measuring maternal HIV incidence using routine surveillance systems are undefined. We used programmatic data from routine antenatal care (ANC) HIV testing in Botswana to measure real-world HIV incidence during pregnancy. Methods: From January 2018 to September 2019, the Botswana Ministry of Health and Wellness implemented an HIV testing program at 139 ANC clinics. The program captured information on testers’ age, testing date and result, and antiretroviral treatment (ART) initiation. In our analysis, we excluded individuals who previously tested HIV-positive prior to their first ANC visit. We defined incident HIV infection as testing HIV-positive at an ANC visit after a prior HIV-negative result within ANC. Results: Overall, 29,570 pregnant women (median age 26 years, IQR 22-31) tested for HIV at ANC clinics: 3% (836) tested HIV-positive at their first recorded ANC visit and 97% tested HIV-negative (28,734). Of those who tested HIV-negative, 28% (7,940/28,734) had a repeat HIV test recorded at ANC. The median time to HIV re-testing was 92 days (IQR 70-112). In total, 17 previously undiagnosed HIV infections were detected (HIV incidence 8 per 1,000 person-years, 95% CI 0.5-1.3). ART initiation among women newly diagnosed with HIV at ANC (853) was 88% (671/762). Conclusions: In Botswana, real-world HIV incidence among pregnant women at ANC remains above levels of HIV epidemic control (≤1 per 1,000 person-years). This study shows how HIV programmatic data can answer timely population-level epidemiological questions and inform ongoing implementation of HIV prevention and treatment programs.

Download Full-text

HIV-Positive Out-of-Treatment Drug Users Who are Unaware of Their HIV Status: Predictors of Who Gets Tested and Who Returns for Test Results

Journal of Drug Issues ◽

10.1177/002204260203200401 ◽

2002 ◽

Vol 32 (4) ◽

pp. 1017-1032 ◽

Cited By ~ 1

Author(s):

Shiela M. Strauss ◽

Sherry Deren ◽

David M. Rindskopf ◽

Gregory P. Falkin

Keyword(s):

Hiv Testing ◽

Risk Behaviors ◽

Drug Users ◽

Hiv Positive ◽

Test Results ◽

Hiv Status ◽

Biological Specimen ◽

The Past ◽

Hiv Test ◽

Using Data

Many HIV positive drug users are unaware that they have the virus, either because they never obtained testing for HIV or because they submitted a biological specimen for testing but never returned to obtain the result of the test. Using data collected from a large multi-site sample of out-of-treatment HIV positive drug users (N=1,544), we identify a variety of socio-demographic characteristics and drug use and sexual risk behaviors that differentiate HIV-positive individuals who had obtained HIV testing in the past and those who had not and, among those who had been tested, what differentiates individuals who had returned to obtain their HIV test results and those who had failed to return. Results of the analyses suggest that there is a need to target different subgroups of high risk drug users for interventions to obtain HIV testing as compared with those that need encouragement to obtain the results of this testing.

Download Full-text

SURPRISING RESULTS: HIV TESTING AND CHANGES IN CONTRACEPTIVE PRACTICES AMONG YOUNG WOMEN IN MALAWI

Journal of Biosocial Science ◽

10.1017/s002193201500022x ◽

2015 ◽

Vol 48 (2) ◽

pp. 174-191 ◽

Cited By ~ 3

Author(s):

Christie Sennott ◽

Sara Yeatman

Keyword(s):

Condom Use ◽

Hiv Testing ◽

Fixed Effects ◽

Population Based ◽

Hiv Positive ◽

Unexpected Result ◽

Hiv Status ◽

Logistic Regression Models ◽

New Information ◽

Hiv Test

SummaryThis study uses eight waves of data from the population-based Tsogolo la Thanzi study (2009–2011) in rural Malawi to examine changes in young women’s contraceptive practices, including the use of condoms, non-barrier contraceptive methods and abstinence, following positive and negative HIV tests. The analysis factors in women’s prior perceptions of their HIV status that may already be shaping their behaviour and separates surprise HIV test results from those that merely confirm what was already believed. Fixed-effects logistic regression models show that HIV testing frequently affects the contraceptive practices of young Malawian women, particularly when the test yields an unexpected result. Specifically, women who are surprised to test HIV positive increase their condom use and are more likely to use condoms consistently. Following an HIV-negative test (whether a surprise or expected), women increase their use of condoms and decrease their use of non-barrier contraceptives; the latter may be due to an increase in abstinence following a surprise negative result. Changes in condom use following HIV testing are robust to the inclusion of potential explanatory mechanisms, including fertility preferences, relationship status and the perception that a partner is HIV positive. The results demonstrate that both positive and negative tests can influence women’s sexual and reproductive behaviours, and emphasize the importance of conceptualizing of HIV testing as offering new information only insofar as results deviate from prior perceptions of HIV status.

Download Full-text

Improving uptake of prevention of mother-to-child HIV transmission services in Benue State, Nigeria through a faith-based congregational strategy

PLoS ONE ◽

10.1371/journal.pone.0260694 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260694

Author(s):

Michele Montandon ◽

Timothy Efuntoye ◽

Ijeoma U. Itanyi ◽

Chima A. Onoka ◽

Chukwudi Onwuchekwa ◽

...

Keyword(s):

Pregnant Women ◽

Hiv Testing ◽

Hiv Transmission ◽

Male Partner ◽

Hiv Positive ◽

Linkage Data ◽

Hiv Status ◽

Faith Based ◽

Hiv Test ◽

The Impact

Background Nigeria has low antiretroviral therapy (ART) coverage among HIV-positive pregnant women. In a previous cluster-randomized trial in Nigeria, Baby Shower events resulted in higher HIV testing coverage and linkage of pregnant women to ART; here, we assess outcomes of Baby Shower events in a non-research setting. Methods Baby Shower events, including a prayer ceremony, group education, music, gifting of a “mama pack” with safe delivery supplies, and HIV testing with ART linkage support for HIV-positive pregnant women, were conducted in eighty sites in Benue State, Nigeria. Client questionnaires (including demographics, ANC attendance, and HIV testing history), HIV test results, and reported linkage to ART were analyzed. Descriptive data on HIV testing and ART linkage data for facility-based care at ANC clinics in Benue State were also analyzed for comparison. Results Between July 2016 and October 2017, 10,056 pregnant women and 6,187 male partners participated in Baby Shower events; 61.5% of women attended with a male partner. Nearly half of female participants (n = 4515, 44.9%) were not enrolled in ANC for the current pregnancy, and 22.3% (n = 2,241) of female and 24.8% (n = 1,532) of male participants reported they had never been tested for HIV. Over 99% (n = 16,240) of participants had their HIV status ascertained, with 7.2% of females (n = 724) and 4.0% of males (n = 249) testing HIV-positive, and 2.9% of females (n = 274) and 2.3% of males (n = 138) receiving new HIV-positive diagnoses. The majority of HIV-positive pregnant women (93.0%, 673/724) were linked to ART. By comparison, at health facilities in Benue State during a similar time period, 99.7% of pregnant women had HIV status ascertained, 8.4% had a HIV-positive status, 2.1% were newly diagnosed HIV-positive, and 100% were linked to ART. Conclusion Community-based programs such as the faith-based Baby Shower intervention complement facility-based approaches and can reach individuals who would not otherwise access facility-based care. Future Baby Showers implementation should incorporate enhanced support for ART linkage and retention to maximize the impact of this intervention on vertical HIV transmission.

Download Full-text

HIV-related mortality at a district hospital in Botswana

International Journal of STD & AIDS ◽

10.1177/0956462416646492 ◽

2016 ◽

Vol 28 (3) ◽

pp. 277-283 ◽

Cited By ~ 3

Author(s):

Melissa EO Perry ◽

Kitenge Kalenga ◽

Louise Francois Watkins ◽

Japheth E Mukaya ◽

Kathleen M Powis ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Testing ◽

Tertiary Hospital ◽

Mortality Data ◽

Hiv Positive ◽

Hiv Status ◽

Surveillance Period ◽

Hospital System ◽

Cd4 Cell Count ◽

Hiv Negative

We reviewed mortality data among medical inpatients at a tertiary hospital in Botswana to identify risk factors for adverse inpatient outcomes. This review was a prospective analysis of inpatient admissions. All medical admissions to male and female medical wards were recorded over a six-month period between 1 November 2011 and 30 April 2012. Data collected included patient demographics, HIV status (positive, negative, unknown), HIV testing history, HIV related treatment and serological history, admission and discharge diagnoses, and mortality status at final discharge or transfer. Of 972 patients admitted during the surveillance period, 427 (43.9%) were known to be HIV-positive on admission, 144 (14.8%) were known to be HIV-negative, and 401 (41.3%) had an unknown HIV status. Of those with unknown status, 131 (32.7%) were tested for HIV during admission and among these 35 (27.5%) were HIV-positive. Including patients with known mortality status following transfer, 172 (17.9%) patients died during the hospitalization. Death occurred in 105 (23%) of known HIV-positive patients, compared with 31 (13%) of known HIV-negative patients (p = 0.002, HR = 1.56 in adjusted analyses). Among HIV-positive patients who died, a low CD4 cell count (<200 cells/mm3) was associated with death. Overall, patients who died had significantly more neurological and respiratory-related presenting complaints than patients who survived. In conclusion, we identified higher overall mortality among HIV-positive patients at a tertiary hospital in Botswana, and low rates of in-hospital HIV testing and antiretroviral therapy initiation. These data demonstrate that despite available antiretroviral therapy in the population for over a decade, HIV continues to add excess burden to the hospital system and adds to inpatient mortality in Botswana.

Download Full-text