Incidence of HIV-Related Hospital Admission and Inpatient Mortality in Malawi (2012-2019): A Population Cohort Study

Methods—We used multiple imputation and negative binomial regression to estimate population age- and sex-specific admission rates over time.We used a log-binomial model to investigate trends in risk of in-hospital death. Results—Of 32,814 adult medical admissions during Q4.2012-Q3.2019, HIV status was recorded for 75.6%. HIV-positive admissions decreased substantially between 2012 and 2019. After imputation for missing data, HIV positive admissions were highest in Q3.2013 (173 per 100,000 adult Blantyre residents) and lowest in Q3.2019 (53 per 100,000 residents). An estimated 10,818 fewer than expected people living with HIV (PLHIV) (95%CI 10,068-11,568) were admitted during 2012-2019 compared to the counterfactual situation where admission rates stayed the same throughout this period. Absolute reductions were greatest for women aged 25-34 years (2,264 fewer HIV-positive admissions, 95%CI 2,002-2,526). In-hospital mortality for PLHIV was 23.5%, with no significant change over time in any age-sex group, and no association with ART use at admission. Conclusions—Rates of admission for adult PLHIV decreased substantially, likely due to large increases in community provision of HIV diagnosis, treatment and care. However, HIV positive in-hospital deaths remain unacceptably high, despite improvements in ART coverage. A concerted research and implementation agenda is urgently needed to reduce inpatient deaths among PLHIV