An audit of HIV-infected Patients Admitted to Helen Joseph Hospital in Johannesburg, South Africa

ABSTRACT Background: South Africa has the largest HIV-infected population and treatment programme in the world. ART access has increased since 2004 with the current policy of universal test and treat (UTT). South Africa has had some success toward the UNAIDS 90-90-90 targets but high numbers of HIV related complications and treatment failure persist despite universal access to ART. The aim of this study was to assess the proportion of patients admitted to a general medical ward with HIV infection and to calculate the median CD4 count of these patients. Methods: A clinical audit in which baseline data was collected from all patients admitted to a single medical unit at Helen Joseph Hospital in Johannesburg from September 2018 to January 2019. The number of admissions of people living with HIV (PLWH) was assessed and median CD4 count and viral loads were calculated. The indications for admission of PLWH and HIV-negative patients were also compared. Results: The median CD4 cell count of PLWH was 67 cells/µl (IQR 23-259.5). Of the 794 medical admissions 42.4% were HIV-infected. Of the cohort of HIV-infected patients, over a quarter were newly diagnosed on admission. Furthermore, 46.1% of patients on treatment were failing ART. More than 10% of HIV-infected patients had interrupted treatment and 10.5% of patients previously known to be HIV-infected had not yet initiated treatment. AIDS-defining conditions accounted for 40.1% of the admissions. Conclusion: Despite a policy of UTT, a high proportion of medical admissions to a public hospital in South Africa are in PLWH. Median CD4 counts remain low in hospitalised HIV positive patients despite universal access to ART. Large numbers of PLWH are not accessing or are disengaging from HIV care.