Research

Impact of endemic HIV on emergency care service delivery in South Africa

E A Hahn, G Mwinnyaa, A Rao, L Wallis, J Black, R Maharaj, A Pousson, S J Reynolds, T C Quinn, B Hansoti

Abstract


Background. South Africa (SA) has the highest burden of HIV in the world. This study sought to evaluate the impact of high HIV prevalence on the burden of disease in an emergency department (ED).

Objectives. To determine the burden of comorbidities in HIV-positive emergency care patients, their demographic profiles and severity of illness were compared with the general ED population in order to make recommendations for resource allocation and training in EDs in SA.

Methods. A prospective cross-sectional observational study was conducted from June 2017 to July 2018 in three EDs in Eastern Cape Province. All eligible patients (aged ≥18 years, fully conscious and clinically stable) presenting to the ED during the 6-week study period were approached and asked to give consent for a point-of-care HIV test and collection of demographic information. Simple descriptive statistics were used to analyse data. Log binomial and Poisson models were fitted to estimate prevalence ratios (PRs).

Results. Over the total study period, 8 000 patients presented to the ED for care across all sites and 3 537 patients were enrolled. The HIV status of 2 901 individuals (82.0%) was determined. Of those who were screened, 811 (28.0%) were identified as HIV-positive. Medical complaints were more common in HIV-positive patients (n=586, 72.3%) than in trauma patients (n=225, 27.7%). In comparison, HIV-negative patients reported fewer medical complaints (n=1 137, 54.4%) and more trauma (n=953, 45.6%) (p<0.001). HIV-positive patients were more likely to have a life-threatening emergency (n=192, 23.7%) (p=0.004), to be critically ill by triage score (p<0.001) and to be admitted to the hospital (p<0.001) than those who were HIV-negative. Despite high acuity overall, people living with HIV/AIDS were significantly less likely to be deemed critically ill according to vital signs (adjusted PR 0.94; p=0.046).

Conclusions. While EDs in SA provide care to high volumes of patients with trauma-related injuries, in areas where HIV prevalence is highest, patients are more likely to present with acute medical emergencies. Providers of emergency care in SA need to be well versed in the management of HIV and associated complications.

 


Authors' affiliations

E A Hahn, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA

G Mwinnyaa, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md., USA

A Rao, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA

L Wallis, Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

J Black, Department of Infectious Disease, Livingstone Hospital, Port Elizabeth, South Africa

R Maharaj, Department of Emergency Medicine, Livingstone Hospital, Port Elizabeth, South Africa

A Pousson, Johns Hopkins School of Medicine, Baltimore, Md., USA

S J Reynolds, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA; Johns Hopkins School of Medicine, Baltimore, Md., USA

T C Quinn, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md., USA; Johns Hopkins School of Medicine, Baltimore, Md., USA

B Hansoti, Johns Hopkins School of Medicine, Baltimore, Md., USA

Full Text

PDF (210KB)

Keywords

HIV; Comorbidity; Co-infection; Emergency department; Prevalence

Cite this article

South African Medical Journal 2020;110(3):217-222. DOI:10.7196/SAMJ.2020.v110i3.14174

Article History

Date submitted: 2020-02-26
Date published: 2020-02-26

Article Views

Abstract views: 230
Full text views: 371

Comments on this article

*Read our policy for posting comments here