{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:42:26Z","timestamp":1787805746711,"version":"build-2784847793"},"reference-count":22,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T00:00:00Z","timestamp":1576627200000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Antiretroviral therapy (ART) has significantly improved survival in Africa in recent years. In Botswana, where adult HIV prevalence is 21.9%, AIDS\u2010related mortality is estimated to have declined by 58% between 2005 and 2013 following the initial wide\u2010spread introduction of ART, and ART coverage has steadily increased reaching 84% in 2016. However, there remains little data about the burden of HIV and its impact on mortality in the hospital setting where most deaths occur. We aimed to describe the burden of HIV and related morbidity and mortality among hospitalized medical patients in a district hospital in southern Botswana in the era of widespread ART coverage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively reviewed medical admissions to Scottish Livingstone Hospital from December 2015 to November 2017 and recorded HIV status, demographics, clinical characteristics and final diagnoses at discharge, death or transfer. We ascertained outcomes and determined factors associated with mortality. Results were compared with similar surveillance data collected at the same facility in 2011 to 2012.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 2316 admissions occurred involving 1969 patients; 42.4% were of HIV\u2010positive patients, 46.9% of HIV\u2010negative patients and 10.7% of patients with unknown HIV status. Compared to HIV\u2010negative patients, HIV\u2010positive patients had younger age (mean 42 vs. 64\u00a0years, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001) and higher mortality (22.2% vs. 18.0%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03). Tuberculosis was the leading diagnosis among mortality cases in both groups but accounted for a higher proportion of deaths among HIV\u2010positive admissions (44.5%) compared with HIV\u2010negative admissions (19.4%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001). Compared with similar surveillance in 2011 to 2012, HIV prevalence was lower (42.4% vs. 47.6%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.01), and among HIV\u2010positive admissions: ART coverage was higher (72.2% vs. 56.2%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001), viral load suppression was similar (78.6% vs. 80.3%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.77), CD4 counts were higher (55.0% vs. 44.6% with CD4 \u2265200\u00a0cells\/mm<jats:sup>3<\/jats:sup>, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), mortality was similar (22.2 vs. 22.7%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.93), tuberculosis diagnoses increased (27.5% vs. 20.1%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.01) and tuberculosis\u2010associated mortality was higher (35.9% vs. 24.7%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite high ART\u2010coverage in Botswana, HIV\u2010positive patients continue to be disproportionately represented among hospital admissions and deaths. Deaths from tuberculosis may be contributing to lack of reduction in inpatient mortality. Our findings suggest that control of HIV and tuberculosis remain top priorities for reducing inpatient mortality in Botswana.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25428","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T11:31:39Z","timestamp":1576668699000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["HIV\u2010associated morbidity and mortality in a setting of high ART coverage: prospective surveillance results from a district hospital in Botswana"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2242-1389","authenticated-orcid":false,"given":"Tomer","family":"Barak","sequence":"first","affiliation":[{"name":"Botswana\u2010Harvard AIDS Institute Partnership Gaborone Botswana"},{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston MA USA"},{"name":"Department of Medicine Scottish Livingstone Hospital Molepolole Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dayna T","family":"Neo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Beth Israel Deaconess Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2048-3973","authenticated-orcid":false,"given":"Neo","family":"Tapela","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Institute Partnership Gaborone Botswana"},{"name":"Nuffield Department of Population Health University of Oxford Oxford United Kingdom"},{"name":"Division of Global Health &amp; Equity Brigham &amp; Women's Hospital Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Mophuthegi","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Institute Partnership Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5707-421X","authenticated-orcid":false,"given":"Rebbeca","family":"Zash","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Institute Partnership Gaborone Botswana"},{"name":"Division of Infectious Disease Beth Israel Deaconess Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketenga","family":"Kalenga","sequence":"additional","affiliation":[{"name":"Department of Medicine Scottish Livingstone Hospital Molepolole Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9280-5273","authenticated-orcid":false,"given":"Melissa EO","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Medicine Western Health and Social Care Trust Londonderry United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mompati","family":"Malane","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Institute Partnership Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0017-2438","authenticated-orcid":false,"given":"Joseph","family":"Makhema","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Institute Partnership Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5384-9716","authenticated-orcid":false,"given":"Shahin","family":"Lockman","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Institute Partnership Gaborone Botswana"},{"name":"Department of Immunology and Infectious Diseases Harvard T.H. Chan School of Public Health Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4832-6275","authenticated-orcid":false,"given":"Roger","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Botswana\u2010Harvard AIDS Institute Partnership Gaborone Botswana"},{"name":"Division of Infectious Disease Beth Israel Deaconess Medical Center Boston MA USA"},{"name":"Department of Immunology and Infectious Diseases Harvard T.H. 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