HIV Testing and Epidemiology in a Hospital-Based Surgical Cohort in Malawi
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.
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.
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.
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.
- 1.USAID (2011) HIV/AIDS Health Profile Southern Africa. Available at http://transition.usaid.gov/our_work/global_health/aids/Countries/africa/southernafrica_profile.pdf. Accessed 1 May 2013
- 2.Bowie C (2006) The burden of disease in Malawi. Malawi Med J 18(3):103–110Google Scholar
- 4.National Statistical Office (NSO) (Malawi) and ORC Macro (Calverton, MD, USA) (2001) Malawi Demographic and Health Survey 2000. Available at www.measuredhs.com/pubs/pdf/FR123/FR123.pdf. Accessed 6 May 2013
- 5.National Statistical Office (NSO) (Malawi) and ORC Macro (Calverton, MD, USA) (2011) Malawi Demographic and Health Survey 2010. Available at www.measuredhs.com/pubs/pdf/FR247/FR247.pdf. Accessed 6 May 2013
- 6.UNAIDS (2010) Malawi HIV and AIDS Monitoring and Evaluation Report 2008–2009. Available at http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2010countries/malawi_2010_country_progress_report_en.pdf. Accessed 6 May 2013
- 8.Malawi Ministry of Health (2009) Guidelines for HIV Testing and Counseling (HTC), 3rd ed. Available at http://www.hivunitmohmw.org/Main/HIVTesting. Accessed 6 May 2013