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

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dc.contributor.authorde Cherif, Teresaen_ZA
dc.contributor.authorSchoeman, Janen_ZA
dc.contributor.authorCleary, Susanen_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.contributor.authorRebe, Kevinen_ZA
dc.contributor.authorMaartens, Garyen_ZA
dc.date.accessioned2015-10-30T09:30:47Z
dc.date.available2015-10-30T09:30:47Z
dc.date.issued2009en_ZA
dc.description.abstractBACKGROUND: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.identifier.apacitationde Cherif, T., Schoeman, J., Cleary, S., Meintjes, G., Rebe, K., & Maartens, G. (2009). Early severe morbidity and resource utilization in South African adults on antiretroviral therapy. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14509en_ZA
dc.identifier.chicagocitationde Cherif, Teresa, Jan Schoeman, Susan Cleary, Graeme Meintjes, Kevin Rebe, and Gary Maartens "Early severe morbidity and resource utilization in South African adults on antiretroviral therapy." <i>BMC Infectious Diseases</i> (2009) http://hdl.handle.net/11427/14509en_ZA
dc.identifier.citationde 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.ris TY - Journal Article AU - de Cherif, Teresa AU - Schoeman, Jan AU - Cleary, Susan AU - Meintjes, Graeme AU - Rebe, Kevin AU - Maartens, Gary AB - 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. DA - 2009 DB - OpenUCT DO - 10.1186/1471-2334-9-205 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2009 T1 - Early severe morbidity and resource utilization in South African adults on antiretroviral therapy TI - Early severe morbidity and resource utilization in South African adults on antiretroviral therapy UR - http://hdl.handle.net/11427/14509 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14509
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-9-205
dc.identifier.vancouvercitationde Cherif T, Schoeman J, Cleary S, Meintjes G, Rebe K, Maartens G. Early severe morbidity and resource utilization in South African adults on antiretroviral therapy. BMC Infectious Diseases. 2009; http://hdl.handle.net/11427/14509.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2009 de Cherif et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherAntiretroviral Therapyen_ZA
dc.subject.otherHealth Resourcesen_ZA
dc.subject.otherHIV Infectionsen_ZA
dc.subject.otherMorbidityen_ZA
dc.subject.otherTreatment Outcomeen_ZA
dc.titleEarly severe morbidity and resource utilization in South African adults on antiretroviral therapyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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