An audit of HIV positive patients admitted to Helen Joseph Hospital in Johannesburg, South Africa

Abstract

Background: South Africa has the largest HIV infected population and treatment programme in the world. ART access has increased since 2004 with the current policy of universal test and treat. South Africa has had some success toward the UNAIDS 90-90-90 targets but high numbers of HIV related complications and treatment failure persist despite universal access to ART. The aim of this study was to estimate the proportion of patients being admitted to medical wards that are HIV infected and to calculate the median CD4 count for these patients. Methods: A prospective descriptive study in which baseline data was collected from medical patients admitted to Helen Joseph Hospital, in Johannesburg from September 2018 to January 2019. The number of HIV infected admissions was assessed and median CD4 count and viral load was calculated. Reasons for admission among HIV infected and non-infected patients were compared. Results: The median CD4 cell count for HIV positive admissions was 67 cells/μl (IQR 23-259.5) 42.4% of 794 medical admissions were HIV infected. Over a quarter of HIV-related admissions were newly diagnosed on admission. 46.1% of patients on treatment were failing ART. More than10% of HIV-infected patients had interrupted treatment with a similar number of patients previously known to be HIV infected having not yet initiated treatment. AIDS defining conditions accounted for more than 40% of reasons for admission. Conclusion: Median CD4 counts remain low in hospitalised HIV positive patients despite universal access to ART. Large numbers of HIV patients are not accessing or are disengaging from HIV care