BACKGROUND: Children living with HIV in low-income countries contribute disproportionately to death after hospital discharge. This study investigates the effect of HIV on post-discharge mortality and readmission by exploring a wide range of clinical, maternal and socioeconomic variables. METHODS: A secondary analysis of children under 5 years old admitted with suspected sepsis. Participants were enrolled from two multisite observational studies conducted from 2012 to 2013 and 2017 to 2020 across six hospitals in Uganda. Participants were excluded if admitted outside the catchment area, for trauma, short-term observation or if admitted immediately after birth without prior discharge. We used a robust Poisson regression to identify risk factors of post-discharge mortality for three separate HIV groups: children living with HIV (CLHIV), children HIV-exposed uninfected (CHEU) and children HIV-unexposed uninfected (CHUU). We implemented Kaplan Meier curves to compare rates of post-discharge mortality and readmission between the three groups. In addition, we compared the risk ratio of the two outcomes. RESULTS: Of the 7658 children who were discharged alive and completed the 6-month follow-up, 266 (3.5%) were CLHIV, 458 (6.0%) were CHEU and 6934 (90.6%) were CHUU. Post-discharge mortality was statistically significantly higher in CLHIV compared to the CHUU, with rates of 12.8% (34/266) and 5.8% (402/6934), respectively. Contrastingly, readmission was higher in CHUU (17.7% (1227/6934)) compared to CLHIV (11.3% (30/266)). Severe malnutrition, indicated by a weight-for-age z-score of less than -3, was associated with post-discharge mortality among all three groups with aRRs of 4.32 (95% CI: 1.89-9.81), 3.96 (95% CI: 1.75-8.95) and 4.84 (95% CI: 3.94-5.96) for CLHIV, CHEU and CHUU, respectively, compounded by the fact that severe malnutrition is disproportionately higher in those living with HIV. Variables associated with post-discharge mortality in this group were prior antimalarial use (aRR = 2.27 95% CI: 1.16-4.47) and moderate anaemia (aRR = 2.33 95% CI: 1.12-4.89). CONCLUSIONS: Children living with HIV represent an exceptionally vulnerable group following hospital discharge. Very low readmission rates alongside high mortality suggest that strategies to improve care transitions and follow-up in these children are essential to improving recovery and survival.
Mackenzie et al. (Thu,) studied this question.