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HIV Testing and Epidemiology in a Hospital-Based Surgical Cohort in Malawi

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Abstract

Background

Despite the high prevalence of HIV in adults (11 %) in Malawi, testing among surgical patients is not routine. We examined the feasibility of universal opt-out HIV testing and counseling (HTC) on the surgical wards of Kamuzu Central Hospital in Lilongwe, Malawi, and sought to further delineate the role of HIV in surgical presentation and outcome.

Methods

We reviewed HTC and surgical admission records from May to October 2011 and compared these data to data collected prospectively on patients admitted from November 2011 through April 2012, after universal HTC implementation.

Results

Prior to universal HTC, 270 of the 2,606 (10.4 %) surgical admissions were tested; 13 % were HIV-infected. After universal HTC implementation, HTC counselors reviewed 1,961 of the 2,488 admissions (79 %): 310 (16 %) had known status (157 seropositive, 153 seronegative) and 1,651 had unknown status (81 %). Among those with unknown status, 97 % (1,598, of 64 % of all admissions) accepted testing, of whom 9 % were found to be HIV-infected. Patients with longer lengths of stay (LOS) (mean = 11 vs. 5 days, p < 0.01) and those who underwent surgical intervention (odds ratio [OR] 2.5; confidence interval [CI] 2.0–3.1) were more likely to have a known status on discharge. HIV was more prevalence in patients with infection and genital/anal warts or ulcers and lower in trauma patients. HIV-positive patients received less surgical intervention (OR 0.69; CI 0.52–0.90), but there was no association between HIV status and length of stay or mortality.

Conclusions

Universal opt-out HTC on the surgical wards was well accepted and increased the proportion of patients tested. High HIV prevalence in this setting merits implementation of universal HTC.

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Authors and Affiliations

  1. University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Bryce E. Haac

  2. Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Anthony G. Charles

  3. UNC Project-Malawi, Lilongwe, Malawi

    Anthony G. Charles, Mitch Matoga & Mina Hosseinipour

  4. Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA

    Sylvia M. LaCourse

  5. The Lighthouse Trust, Lilongwe, Malawi

    Dominic Nonsa

  6. Center for Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Mina Hosseinipour

Authors
  1. Bryce E. Haac
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  2. Anthony G. Charles
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  3. Mitch Matoga
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  4. Sylvia M. LaCourse
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  5. Dominic Nonsa
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  6. Mina Hosseinipour
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Corresponding author

Correspondence to Anthony G. Charles.

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Haac, B.E., Charles, A.G., Matoga, M. et al. HIV Testing and Epidemiology in a Hospital-Based Surgical Cohort in Malawi. World J Surg 37, 2122–2128 (2013). https://doi.org/10.1007/s00268-013-2096-4

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