HIV Treatment Costs High at Inpatient Care Facilities in South Africa.
Inpatient medical facilities in South Africa shoulder a substantial burden from treating HIV-positive patients who are not receiving antiretroviral therapy, even in an era when such treatments are available on a large scale, according to a new study co-authored by a School of Public Health researcher.
The study, in the journal PLOS ONE, found that HIV-positive patients accounted for at least 55 percent of all resources utilized (i.e. bed days) at a regional hospital in Johannesburg. Researchers analyzed a random sample of more than 1,000 inpatient admissions in 2010.
Only 36 percent of the HIV-positive patients were reported to be on antiretroviral therapy (ART) at the time of admission, despite the majority being eligible for ART based on their blood counts. The HIV-positive patients had longer average hospitalizations compared to other patients.
The findings suggest that the burden of HIV on South African hospitals “may not have changed substantially” since ART became widely available in 2004, the study says.
“The majority of the burden of HIV inpatient care on hospitals is related to patients not on ART, (and) this burden is large, accounting for more than half of all inpatient resources,” the authors said. Their analysis indicated that while the prevalence of HIV in adults, ages 15–49, was 17.8 percent in 2012—less than one-fifth of the total population—those patients consumed more than 50 percent of the available resources in inpatient facilities.
The three most common reasons for admission were tuberculosis and other mycobacterial infections, cardiovascular disorders, and bacterial infections. The majority of tuberculosis and bacterial infections were found among HIV-positive patients.
The research team estimated that the annual cost of hospitalizations for patients on ART in South Africa exceeded $246 million.
“Diminishing this excess burden through earlier ART initiation and better medication adherence—high priorities of the South African government—may free up additional capacity and reduce the cost of treating HIV patients, adding further evidence of the importance of these goals,” the authors said.
SPH co-authors on the study include Matthew Fox, associate professor of epidemiology and a researcher with the Center for Global Health & Development, and Sydney Rosen, research professor of global health. Other authors are from the University of Witwatersrand, Johannesburg, South Africa.