Early severe morbidity and resource utilization in South African adults on antiretroviral therapy

 

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dc.contributor.author de Cherif, Teresa en_ZA
dc.contributor.author Schoeman, Jan en_ZA
dc.contributor.author Cleary, Susan en_ZA
dc.contributor.author Meintjes, Graeme en_ZA
dc.contributor.author Rebe, Kevin en_ZA
dc.contributor.author Maartens, Gary en_ZA
dc.date.accessioned 2015-10-30T09:30:47Z
dc.date.available 2015-10-30T09:30:47Z
dc.date.issued 2009 en_ZA
dc.identifier.citation de Cherif, T. K., Schoeman, J. H., Cleary, S., Meintjes, G. A., Rebe, K., & Maartens, G. (2009). Early severe morbidity and resource utilization in South African adults on antiretroviral therapy. BMC infectious diseases, 9(1), 205. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14509
dc.identifier.uri http://dx.doi.org/10.1186/1471-2334-9-205
dc.description.abstract BACKGROUND:High rates of mortality and morbidity have been described in sub-Saharan African patients within the first few months of starting highly active antiretroviral therapy (HAART). There is limited data on the causes of early morbidity on HAART and the associated resource utilization. METHODS: A cross-sectional study was conducted of medical admissions at a secondary-level hospital in Cape Town, South Africa. Patients on HAART were identified from a register and HIV-infected patients not on HAART were matched by gender, month of admission, and age group to correspond with the first admission of each case. Primary reasons for admission were determined by chart review. Direct health care costs were determined from the provider's perspective. RESULTS: There were 53 in the HAART group with 70 admissions and 53 in the no-HAART group with 60 admissions. The median duration of HAART was 1 month (interquartile range 1-3 months). Median baseline CD4 count in the HAART group was 57 x 106 cells/L (IQR 15-115). The primary reasons for admission in the HAART group were more likely to be due to adverse drug reactions and less likely to be due to AIDS events than the no-HAART group (34% versus 7%; p < 0.001 and 39% versus 63%; p = 0.005 respectively). Immune reconstitution inflammatory syndrome was the primary reason for admission in 10% of the HAART group. Lengths of hospital stay per admission and inpatient survival were not significantly different between the two groups. Five of the 15 deaths in the HAART group were due to IRIS or adverse drug reactions. Median costs per admission of diagnostic and therapeutic services (laboratory investigations, radiology, intravenous fluids and blood, and non-ART medications) were higher in the HAART group compared with the no-HAART group (US$190 versus US$111; p = 0.001), but the more expensive non-curative costs (overhead, capital, and clinical staff) were not significantly different (US$1199 versus US$1128; p = 0.525). CONCLUSIONS: Causes of early morbidity are different and more complex in HIV-infected patients on HAART. This results in greater resource utilization of diagnostic and therapeutic services. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an Open Access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source BMC Infectious Diseases en_ZA
dc.source.uri http://www.biomedcentral.com/bmcinfectdis/ en_ZA
dc.subject.other Antiretroviral Therapy en_ZA
dc.subject.other Health Resources en_ZA
dc.subject.other HIV Infections en_ZA
dc.subject.other Morbidity en_ZA
dc.subject.other Treatment Outcome en_ZA
dc.title Early severe morbidity and resource utilization in South African adults on antiretroviral therapy en_ZA
dc.type Journal Article en_ZA
dc.rights.holder 2009 de Cherif et al; licensee BioMed Central Ltd. en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an Open Access article distributed under the terms of the Creative Commons Attribution License Except where otherwise noted, this item's license is described as This is an Open Access article distributed under the terms of the Creative Commons Attribution License