Relationship between HIV serostatus, CD4 count and rehospitalisation: Potential implications for health systems strengthening in South Africa

Background: Despite three decades of scientific response to HIV/AIDS, the generalised HIV epidemic continues to persist in South Africa. There is growing acknowledgement that health system strengthening will be critical in tackling HIV/AIDS. Patient rehospitalisation is an important quality benchmark of health service delivery, but there is currently limited data on rehospitalisation of patients with HIV/AIDS in South Africa, a setting with a high burden of HIV disease. Objectives: To determine the relationship between combined HIV serostatus and CD4 count, and rehospitalisation in South Africa. Methods: This study was a retrospective analysis of data from 11,362 non-surgical adult patients who attended the Hlabisa Hospital in South Africa. Data related to patient age, gender, HIV serostatus, CD4 count (for HIV-positive patients) and comorbidity were analysed through univariate (Fisher’s Exact or χ2 tests) and multivariate (Cox regression) statistical methods to determine associations with rehospitalisation within 1 month (acute rehospitalisation) or 12 months (long term rehospitalisation). Results: An HIV-positive serostatus with CD4 count < 350 cells/mm3 or an HIV-positive serostatus with an unknown CD4 count were independently associated with a higher risk of acute (p = 0.010 and p = 0.003) and long term rehospitalisation (p < 0.001 for both categories) when compared with an HIV-negative serostatus group. Conclusions: HIV-positive individuals with immune deficiency, or lacking a CD4 count measurement are at risk of rehospitalisation. Strengthening primary healthcare service delivery of these key affected inpatient populations should be a priority.