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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.

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  1. USAID (2011) HIV/AIDS Health Profile Southern Africa. Available at Accessed 1 May 2013

  2. Bowie C (2006) The burden of disease in Malawi. Malawi Med J 18(3):103–110

    Google Scholar 

  3. Harries AD, Makombe SD, Libamba E et al (2011) Why did the scale-up of HIV treatment work? A case example from Malawi. J Aquir Immune Defic Syndr 57:S64–S67

    Article  Google Scholar 

  4. National Statistical Office (NSO) (Malawi) and ORC Macro (Calverton, MD, USA) (2001) Malawi Demographic and Health Survey 2000. Available at 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 Accessed 6 May 2013

  6. UNAIDS (2010) Malawi HIV and AIDS Monitoring and Evaluation Report 2008–2009. Available at Accessed 6 May 2013

  7. Jahn A, Floyd S, Crampin AC et al (2008) Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi. Lancet 371(9624):1603–1611

    PubMed  Article  Google Scholar 

  8. Malawi Ministry of Health (2009) Guidelines for HIV Testing and Counseling (HTC), 3rd ed. Available at Accessed 6 May 2013

  9. Lewis DK, Callaghan M, Phiri K et al (2003) Prevalence and indicators of HIV and AIDS among adults admitted to medical and surgical wards in Blantyre, Malawi. Trans R Soc Trop Med Hyg 97(1):91–96

    PubMed  Article  Google Scholar 

  10. Martinson NA, Omar T, Gray GE et al (2007) High rates of HIV in surgical patients in Soweto, South Africa: impact on resource utilisation and recommendations for HIV testing. Trans R Soc Trop Med Hyg 101(2):176–182

    PubMed  Article  Google Scholar 

  11. Cacala SR, Mafana E, Thomson SR et al (2006) Prevalence of HIV status and CD4 counts in a surgical cohort: their relationship to clinical outcome. Ann R Coll Surg Eng 88(1):46–51

    Article  CAS  Google Scholar 

  12. Bhagwanjee S, Muckart D, Jeena PM et al (1997) Does HIV status influence the outcome of patients admitted to a surgical intensive care unit? A prospective double blind study. BMJ 314(7087):1081–1084

    Article  Google Scholar 

  13. Madiba TE, Muckart DJ, Thomson SR (2009) Human immunodeficiency disease: how should it affect surgical decision making? World J Surg 33(5):899–909. doi:10.1007/s00268-009-9969-6

    PubMed  Article  CAS  Google Scholar 

  14. Horberg MA, Hurley LB, Klein DB et al (2006) Surgical outcomes in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. Arch Surg 141(12):1238–1245

    PubMed  Article  Google Scholar 

  15. Wakeman R, Johnson CD, Wastell C (1990) Surgical procedures in patients at risk of human immunodeficiency virus infection. J R Soc Med 83(5):315–318

    PubMed  CAS  Google Scholar 

  16. Consten EC, Slors FJ, Noten HJ et al (1995) Anorectal surgery in human immunodeficiency virus-infected patients. Clinical outcome in relation to immune status. Dis Colon Rectum 38(11):1169–1175

    PubMed  Article  CAS  Google Scholar 

  17. Cohen MS, Chen YQ, McCauley M et al (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365(6):493–505

    PubMed  Article  CAS  Google Scholar 

  18. Powers KA, Ghani AC, Miller WC et al (2011) The role of acute and early HIV infection in the spread of HIV and implications for transmission prevention strategies in Lilongwe, Malawi: a modelling study. Lancet 378(9787):256–268

    PubMed  Article  Google Scholar 

  19. Granich RM, Gilks CF, Dye C et al (2009) Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 373(9657):48–57

    PubMed  Article  Google Scholar 

  20. Lin EY, Brunicardi FC (1994) HIV infection and surgeons. World J Surg 18(5):753–757. doi:10.1007/BF00298922

    PubMed  Article  CAS  Google Scholar 

  21. Consten EC, van Lanschot JJ, Henny PC et al (1995) A prospective study on the risk of exposure to HIV during surgery in Zambia. AIDS 9(6):585–588

    PubMed  Article  CAS  Google Scholar 

  22. McGowan DR, Norris JM, Smith MD et al (2012) Routine testing for HIV in patients undergoing elective surgery. Lancet 380(9846):e5

    PubMed  Article  Google Scholar 

  23. Olapade-Olaopa EO, Salami MA, Afolabi AO (2006) HIV/AIDS and the surgeon. Afr J Med Med Sci 35(Suppl):77–83

    PubMed  Google Scholar 

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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).

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  • Pyomyositis
  • Seronegative Patient
  • Reactive Patient
  • Kamuzu Central Hospital
  • National Health Science Research Committee