Admission trends in a rural south African hospital during the early years of the HIV epidemic

Context Few studies have attempted to quantify the effect of the epidemic o f human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AI DS) on demand for health care in developing countries. More data are requir ed to improve understanding of its impact and to guide development of appro priate response strategies. Objective To assess the HIV/AIDS epidemic's impact on demand for inpatient hospital care in a rural area of South Africa. Design Retrospective analysis of data from general hospital and individual ward admission registers, a tuberculosis program database, and patient case notes. Setting and Patients Patients admitted between 1991 and 1998 to a 450-bed h ospital that serves Hlabisa District, South Africa (population approximate to 200 000), where HIV seroprevalence among antenatal clinic attendees incr eased from 4% in 1992 to 29% in 1998, Main Outcome Measures Number of admissions to 9 hospital wards, number of c linical AIDS and general medical admissions (both excluding tuberculosis), and number of tuberculosis admissions to adult medical wards during the stu dy period. Results Total hospital admissions increased by 81%, from 6562 in 1991 to 11 872 in 1998, Adult tuberculosis ward admissions increased by 360%, from 30 3 to 1393, In 1998, tuberculosis patients accounted for 47% and 30% of adul t male and female medical ward admissions, respectively, and for 11% of tot al hospital admissions. Nontuberculosis clinical AIDS cases increased 43-fo ld, accounting for 4% of adult medical admissions in 1997 vs 0.2% in 1991. Tuberculosis and nontuberculosis clinical AIDS cases were the only types of admission to show a clear and consistent upward trend over the period stud ied. Patterns in other types of admissions varied more and changes were sma ller. Conclusions The HIV/AIDS epidemic has had an important impact on demand for adult tuberculosis and general medical care in a rural South African distr ict hospital. If this impact is shown to extend to other rural South Africa n areas, response strategies are urgently needed.