An analysis of the economic impact of HIV infection among patients at Mama Yemo Hospital, Kinshasa, Zaire.

In a prospective study of adult admissions to the Department of Internal Medicine at Mama Yemo Hospital, Kinshasa, Zaire in late 1988, 129 women and 122 men were screened for HIV infection. Fifty per cent were found to be seropositive, with half of the seropositives meeting the World Health Organization (WHO) clinical AIDS definition. The HIV seropositives had a mortality rate of 50%, which was significantly higher (P = 0.004) than the 30% mortality rate seen in the seronegative group. Direct costs during hospitalization did not differ ($60.30 for HIV seropositives, $56.50 for HIV seronegatives), but pre-hospitalization expenses were significantly higher in the HIV-seropositive group ($170 for HIV seropositives, $110 for HIV seronegatives). Years of productive life lost due to death were also significantly higher for HIV seropositives versus HIV seronegatives (30.6 versus 21.3 years; P = 0.0007), and 73% of the premature mortality in the study population was attributable to HIV infection.

Prevention of perinatal HIV transmission: are there alternatives to pre-pregnancy serological screening in Kinshasa, Zaire?

Complete obstetrical and medical histories were obtained from 6312 women between the ages of 15 and 45 years who had undergone HIV serological tests. Individual factors were examined for sensitivity, specificity and positive predictive value of HIV infection. No individual risk factors for HIV infection were identified which had sensitivities greater than 60%. Combinations of factors were modelled by logistic regression. Only a model which included indicators of present illness with AIDS/HIV-related symptoms (i.e., chronic fever, diarrhea or profound weight loss) was predictive of HIV serostatus. These results suggest that identification of healthy women at high risk of HIV infection using non-serological information is not feasible. Thus, since the yearly cost of universal serological screening is prohibitively expensive in the Zairean context, HIV/AIDS education and prevention campaigns may in fact be a more cost-effective means of preventing perinatal transmission of HIV.

PIP: Complete obstetrical and medical histories were obtained from 6312 women between ages 15-45 who had undergone HIV serological tests. Individual factors were examined for sensitivity, specificity, and positive predictive value of HIV infection. No individual risk factors for HIV infection were identified which had sensitivities 60%. Combinations of factors were modelled by logistic regression. Only a model which included indicators of present illness with AIDS/HIV-related symptoms (chronic fever, diarrhea, or profound weight loss) was predictive of HIV serostatus. These results suggest that identification of healthy women at high risk of HIV infection using nonserological information is not feasible. Thus, since the yearly cost of universal serological screening is prohibitively expensive in Zaire, HIV/AIDS education and prevention campaigns may be a more cost-effective means of preventing perinatal HIV transmission.