Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications
Setting: 100 bed medical ward in referral hospital, Lilongwe, Malawi. Objective: HIV positive patients admitted to hospital often have advanced HIV disease (AHD) and are at risk for mortality. WHO guidelines suggest a package of care for AHD; these are often not implemented, especially in inpatient...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Ubiquity Press
2022-03-01
|
| Series: | Annals of Global Health |
| Online Access: | https://annalsofglobalhealth.org/articles/3532 |
| _version_ | 1811299613004529664 |
|---|---|
| author | Tom Heller Douglas Damba Tapiwa Kumwenda Jacqueline Huwa Christine Kamamia Angellina Nhlema Claudia Wallrauch Chimwemwe Chawinga Cecilia Kanyama Lillian Gondwe-Chunda Jonathan Ngoma Beatrice Matanje Hannock Tweya |
| author_facet | Tom Heller Douglas Damba Tapiwa Kumwenda Jacqueline Huwa Christine Kamamia Angellina Nhlema Claudia Wallrauch Chimwemwe Chawinga Cecilia Kanyama Lillian Gondwe-Chunda Jonathan Ngoma Beatrice Matanje Hannock Tweya |
| author_sort | Tom Heller |
| collection | DOAJ |
| description | Setting: 100 bed medical ward in referral hospital, Lilongwe, Malawi. Objective: HIV positive patients admitted to hospital often have advanced HIV disease (AHD) and are at risk for mortality. WHO guidelines suggest a package of care for AHD; these are often not implemented, especially in inpatient settings. We describe an implementation model for AHD care, its outcomes in routine care and provide cost estimates. Design: An “AHD care room” was established staffed by HIV counselor, nurse, and clinical officer allowing Provider Initiated Testing and Counseling, diagnostic testing for AHD and ensuring availability of HIV and TB drugs for rapid treatment initiation. Results: In the observation period from January to December 2020, a total of 1549 medical inpatients were tested for HIV (coverage 77.1%); 69 tested positive (yield 4.5%). The total proportion of HIV positive was 32.3% (638 already on ART and 69 newly diagnosed). CD4+ testing was done in 460 medical inpatients (65.1%); 245 (53.2%) were below 200 cells/ml and thus met definition of AHD. A total of 238 received S-CrAg tests; 39 (16.3%) were positive; 62 (28.3%) of 219 U-LAM tests were positive. The cost per identification of HIV positive patient was US$ 110.8; per AHD diagnosis between US$ 17.1 to 78.9; per positive S-CrAg test US$ 18.5 and per positive U-LAM test US$ 17.5. Conclusion: Our model successfully implemented AHD services according to WHO guidelines and provides basic costing data. Similar services could be implemented in other hospitals in LMICs. |
| first_indexed | 2024-04-13T06:39:22Z |
| format | Article |
| id | doaj.art-59f22b3ed9e94b949daa3a6bb6ce3fcc |
| institution | Directory Open Access Journal |
| issn | 2214-9996 |
| language | English |
| last_indexed | 2024-04-13T06:39:22Z |
| publishDate | 2022-03-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Annals of Global Health |
| spelling | doaj.art-59f22b3ed9e94b949daa3a6bb6ce3fcc2022-12-22T02:57:48ZengUbiquity PressAnnals of Global Health2214-99962022-03-0188110.5334/aogh.35322725Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost ImplicationsTom Heller0Douglas Damba1Tapiwa Kumwenda2Jacqueline Huwa3Christine Kamamia4Angellina Nhlema5Claudia Wallrauch6Chimwemwe Chawinga7Cecilia Kanyama8Lillian Gondwe-Chunda9Jonathan Ngoma10Beatrice Matanje11Hannock Tweya12Lighthouse Trust, Lilongwe, MW; International Training and Education Center for Health, University of Washington, Seattle, WALighthouse Trust, LilongweLighthouse Trust, LilongweLighthouse Trust, LilongweLighthouse Trust, Lilongwe, MW; International Training and Education Center for Health, University of Washington, Seattle, WALighthouse Trust, LilongweLighthouse Trust, LilongweUNC Project, LilongweUNC Project, Lilongwe; Department of Medicine, Kamuzu Central Hospital, LilongweDepartment of Medicine, Kamuzu Central Hospital, LilongweDepartment of Medicine, Kamuzu Central Hospital, LilongweLighthouse Trust, LilongweLighthouse Trust, LilongweSetting: 100 bed medical ward in referral hospital, Lilongwe, Malawi. Objective: HIV positive patients admitted to hospital often have advanced HIV disease (AHD) and are at risk for mortality. WHO guidelines suggest a package of care for AHD; these are often not implemented, especially in inpatient settings. We describe an implementation model for AHD care, its outcomes in routine care and provide cost estimates. Design: An “AHD care room” was established staffed by HIV counselor, nurse, and clinical officer allowing Provider Initiated Testing and Counseling, diagnostic testing for AHD and ensuring availability of HIV and TB drugs for rapid treatment initiation. Results: In the observation period from January to December 2020, a total of 1549 medical inpatients were tested for HIV (coverage 77.1%); 69 tested positive (yield 4.5%). The total proportion of HIV positive was 32.3% (638 already on ART and 69 newly diagnosed). CD4+ testing was done in 460 medical inpatients (65.1%); 245 (53.2%) were below 200 cells/ml and thus met definition of AHD. A total of 238 received S-CrAg tests; 39 (16.3%) were positive; 62 (28.3%) of 219 U-LAM tests were positive. The cost per identification of HIV positive patient was US$ 110.8; per AHD diagnosis between US$ 17.1 to 78.9; per positive S-CrAg test US$ 18.5 and per positive U-LAM test US$ 17.5. Conclusion: Our model successfully implemented AHD services according to WHO guidelines and provides basic costing data. Similar services could be implemented in other hospitals in LMICs.https://annalsofglobalhealth.org/articles/3532 |
| spellingShingle | Tom Heller Douglas Damba Tapiwa Kumwenda Jacqueline Huwa Christine Kamamia Angellina Nhlema Claudia Wallrauch Chimwemwe Chawinga Cecilia Kanyama Lillian Gondwe-Chunda Jonathan Ngoma Beatrice Matanje Hannock Tweya Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications Annals of Global Health |
| title | Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications |
| title_full | Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications |
| title_fullStr | Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications |
| title_full_unstemmed | Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications |
| title_short | Implementing Advanced HIV Disease Care for Inpatients in a Referral Hospital in Malawi – Demand, Results and Cost Implications |
| title_sort | implementing advanced hiv disease care for inpatients in a referral hospital in malawi demand results and cost implications |
| url | https://annalsofglobalhealth.org/articles/3532 |
| work_keys_str_mv | AT tomheller implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT douglasdamba implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT tapiwakumwenda implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT jacquelinehuwa implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT christinekamamia implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT angellinanhlema implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT claudiawallrauch implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT chimwemwechawinga implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT ceciliakanyama implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT lilliangondwechunda implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT jonathanngoma implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT beatricematanje implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications AT hannocktweya implementingadvancedhivdiseasecareforinpatientsinareferralhospitalinmalawidemandresultsandcostimplications |