The High Cost of HIV-Positive Inpatient Care at an Urban Hospital in Johannesburg, South AfricaReportar como inadecuado

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While most HIV care is provided on an outpatient basis, hospitals continue to treat serious HIV-related admissions, which is relatively resource-intensive and expensive. This study reports the primary reasons for HIV-related admission at a regional, urban hospital in Johannesburg, South Africa and estimates the associated lengths of stay and costs.

Methods and Findings

A retrospective cohort study of adult, medical admissions was conducted. Each admission was assigned a reason for admission and an outcome. The length of stay was calculated for all patients N = 1,041 and for HIV-positive patients n = 469, actual utilization and associated costs were also estimated. Just under half were known to be HIV-positive admissions. Deaths and transfers were proportionately higher amongst HIV-positive admissions compared to HIV-negative and unknown. The three most common reasons for admission were tuberculosis and other mycobacterial infections 18%, n = 187, cardiovascular disorders 12%, n = 127 and bacterial infections 12%, n = 121. The study sample utilized a total of 7,733 bed days of those, 55% 4,259-7,733 were for HIV-positive patients. The average cost per admission amongst confirmed HIV-positive patients, which was an average of 9.3 days in length, was $1,783 United States Dollars.


Even in the era of large-scale antiretroviral treatment, inpatient facilities in South Africa shoulder a significant HIV burden. The majority of this burden is related to patients not on ART 298-469, 64%, and accounts for more than half of all inpatient resources. Reducing the costs of inpatient care is thus another important benefit of expanding access to ART, promoting earlier ART initiation, and achieving rates of ART retention and adherence.

Autor: Lawrence C. Long , Matthew P. Fox, Celeste Sauls, Denise Evans, Ian Sanne, Sydney B. Rosen



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