Post-hospitalization outcomes of people with advanced HIV disease hospitalized in the national Hospital of Donka (Conakry, Guinee)

Approximately one of three people living with HIV presents to healthcare services in an advanced stage, and this proportion is higher in low- and middle-income countries. In Guinea, outcomes during post-hospitalization of patients discharged from inpatient care is not well documented, especially those of people living with HIV. This study aimed to document the outcomes and factors associated with re-admission and mortality of patients with advanced HIV disease (AHD) discharged from inpatient care in the Unit of Care, Training, and Research (USFR) of the Hospital of Donka (Conakry, Guinée). The study is a prospective observational cohort study. All patients discharged from the USFR between September and November 2023 were recruited and followed up for 3 months post-hospitalization. All patients of any age who consented to participate were included, regardless of their state of health at hospital exit (improved, transferred, or placed on palliative care). Ethical approval was sought. Data was analyzed using R software. A total of 150 participants were included. Of them, 89% (n=134) presented at WHO stage IV; 87% (n=130) had CD4 < 200 cells/mm,3 and 65% an HIV RNA viral load of ≥ 1000 copies/mL. After discharge, 22% (n=33) of participants did not keep follow-up appointments at referral centers due to travel (21%), clinical condition deterioration (15%), hospitalization (15%), lack of transport (12%) or lack of accompanying individuals (12%). Post-hospital mortality rate was 31% (n=47). Of these deaths, 74% occurred in the community (n=35). Factors associated with death included WHO stage IV (p=0.022), admission to intensive care (p≤0.001), cerebral tuberculosis (p=0.010), and failure to start antiretroviral treatment within the prescribed time (p<0.001). Readmission rate was 20% (n=20). Factors associated with it were screening for a new clinical condition (p = 0.007), lack of antiretroviral treatment (p = 0.005), and WHO clinical stage (p = 0.022). Essential drugs were out of stock or unavailable for 32% (n=37) of participants. These drugs included cotrimoxazole (51%), corticosteroids (prednisolone) (38%), dolutegravir single formulation (27%), fluconazole, and flucytosine (3%). Patients with AHD are at risk of re-hospitalization and mortality, particularly in the community, due to multifactorial risks. Further research is crucial to inform targeted evidence-based interventions that enhance survival and long-term health trajectories.