THE IMPACT OF HIV ON RESOURCE UTILIZATION BY PATIENTS WITH TUBERCULOSIS IN A TERTIARY REFERRAL HOSPITAL, NAIROBI, KENYA

By using routinely collected data and results from research studies at the Infectious Diseases Hospital (IDH), Nairobi, we have begun to det ermine the scale of the increase in resource utilisation and treatment costs for tuberculosis control services caused by the HIV epidemic. N ew cases of tuberculosis registered annually at the IDH rose 61%, from 447 in 1985 to 720 in 1990. HIV seroprevalence among patients with tu berculosis rose from 7.5% in 1986 to 42% in 1990. The inpatient mortal ity rate rose from 8.4% in 1985 to 16.8% in 1989, but fell to 13.5% in 1990. HIV-positive patients were admitted to hospital on 2 or more oc casions more often than HIV-negative patients (Relative risk (RR) = 2. 46, 95% confidence intervals (CI), 1.1-5.7), but average duration of a dmission was similar for the 2 groups. Significantly more HIV-positive patients were prescribed antibiotics, antifungal agents, antidiarrhoe al agents, analgesics and corticosteriods than HIV-negative patients. Microbiological investigations, apart from those for tuberculosis, wer e performed more commonly among HIV-positive patients (RR = 2.0, 95% C I 1.0-4.2). Using this data, the average cost of ideal drug therapy, i ncluding antituberculosis drugs and treatment for intercurrent infecti ons and other complications, was estimated using 1992 prices (ECHO, Co ulsdon Surrey, UK). The costs were US$16.62 and US$32.94 for HIV-negat ive patients using 'standard' therapy (2STH/10TH) and short course the rapy (2SHRZ/6TH) respectively, and US$41.18 for HIV-positive patients using a short-course regimen without thiacetazone (2EHRZ/6EH). The HIV epidemic is causing both an increase in the numbers of patients requi ring treatment and an increase in the average cost of treatment per pa tients. This latter increase is almost entirely due to the cost of tre ating intercurrent infections other than tuberculosis.