Eligibility for HIV/AIDS Treatment among Adults in a Medical Emergency Setting at an Urban Hospital in Uganda

Background: Despite global effort to scale up access to antiretroviral therapy (ART); many people in need of HIV/AIDS care in Uganda have not been reached. HIV testing and ART are not widely offered as routine medical services and data on HIV/AIDS in emergency settings in Sub-Saharan Africa is limited.We determined the HIV prevalence and eligibility for ART in a medical emergency unit at Mulago hospital. Methods: In a cross-sectional study; we interviewed 223 patients who were systematically selected from the patients'register from October through December 2004. HIV testing was offered routinely and results were delivered within 30 minutes.We evaluated HIV infected patients for WHO clinical stage of disease and referred them for HIV/AIDS care. Results: Out of 223 patients; 111 (50) had HIV infection of whom 78 (70) had WHO clinical stage 3 and 4 of disease thereby requiring ART. Overall; 84 out of 111 (76) HIV positive patients had not received any specific HIV/AIDS care. Conclusion: The burden of HIV infection in the medical emergency unit is high and majority of the patients who required ART had no prior HIV/AIDS care.We recommend scale up of HIV/AIDS care in acute care settings in order to increase access to ART

Treatment of malaria restricted to laboratory confirmed cases: a prospective cohort study in Ugandan children

Background: Presumptive treatment of malaria in febrile children is widely advocated in Africa. This may occur in the absence of diagnostic testing or even when diagnostic testing is performed but fails to detect malaria parasites. Such over-treatment of malaria has been tolerated in the era of inexpensive and safe monotherapy. However; with the introduction of new artemisinin-based combination therapy (ACT); presumptive treatment becomes economically and clinically less acceptable. Methods: The risks and benefits of only treating children with microscopy confirmed malaria using a prospective cohort design were investigated. A representative sample of 601 children between one and 10 years of age were recruited from a census population in Kampala; Uganda and were followed for all of their health care needs in a study clinic. Standard microscopy was performed each time a child presented with a new episode of fever and antimalarial therapy given only if the blood smear was positive. Results: Of 5;895 visits for new medical problems 40were for febrile illnesses. Of the 2;359 episodes of new febrile illnesses; blood smears were initially reported as negative in 1;608 (68) and no antimalarial therapy was given. Six of these initially negative smears were reported to be positive following quality control reading of all blood smears: four of these patients were subsequently diagnosed with uncomplicated malaria and two cleared their parasites without antimalarial treatment. Of the 1;602 new febrile illnesses in which the final blood smear reading was classified as negative; only 13 episodes (0.8) were diagnosed with malaria in the subsequent 7 days. All 13 of these episodes of malaria were uncomplicated and were successfully treated.Conclusions: In this urban setting; malaria was responsible for only 32of febrile episodes. Withholding antimalarial therapy in febrile children with negative blood smears was safe and saved over 1;600 antimalarial treatments in 601 children over an 18-month period. In the era of expensive ACT; directing resources towards improving diagnostic and treatment practices may provide a cost-effective measure for promoting rational use of antimalarial therapy