Prior health seeking behaviour and clinical presentation of patients with first time HIV testing at Medical Admission.

Abstract

Introduction: Delayed therapy is detrimental and costly to patients. In HIV care, this problem has been confounded by the practice of leaving it to patients to decide whether or not to test for HIV. Many HIV infected patients visit health facilities with various illnesses early in the course of the HIV illness and yet they are not tested for HIV. This research sought to describe the health and health care seeking behavior in the six month period before the admission and a first HIV test on the medical wards in Mulago Hospital, and the subsequent morbidity and mortality, highlighting the missed opportunities for early linkage to HIV care. It also depicted the absolute lymphocyte counts and CD4 T lymphocyte counts at the time of the diagnosis of HIV.

Methodology: This was a descriptive cross-sectional study. Two hundred and ninety consecutive patients admitted on wards 4A, 4B and 4C in Mulago hospital who had had their first positive HIV blood test result and who satisfied the inclusion criteria were recruited.

Results: The majority (99.0 %) of the patients had had other illnesses in the preceding six month period. The most common symptoms then were fever, weight loss, cough, anorexia and headache. Most patients had been to private clinics, government hospitals or both. 72.0 % had suspected that they were infected with HIV, but they were not offered a blood test. At admission the patients had between one and four diagnoses. The commonest symptoms at admission were cough, fatigue / malaise, headache, chest pain and generalized abdominal pain. The commonest diagnoses were pulmonary tuberculosis, bronchopneumonia, malaria and cryptococcal meningitis. Many (86%) already had AIDS. Approximately a quarter of the study patients died during the admission, often due to pneumonia.

Conclusions and recommendations: Many patients had been symptomatic prior to admission, with symptoms commonly related to HIV/AIDS. Many patients had suspected they had HIV but had not been tested for HIV despite previously attending formal health facilities. Consequently, the majority of patients had severe immunosuppression at first diagnosis of HIV infection which was at admission. In keeping with other studies, PTB, malaria, bacterial pneumonia and cryptococcal meningitis were the commonest illnesses. Pulmonary symptoms, wasting and headache which are pointers of possible HIV infection (PTB, pneumonia and cryptococcal meningitis) were common. The absolute lymphocyte counts did not correlate with the CD4 T lymphocyte counts. More health facilities should provide routine HIV testing services so that HIV infected patients receive timely HIV care.