Admission trends in a rural South African hospital during the early years of the HIV epidemic.

<bold>Context: </bold>Few studies have attempted to quantify the effect of the epidemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) on demand for health care in developing countries. More data are required to improve understanding of its impact and to guide development of appropriate response strategies.<bold>Objective: </bold>To assess the HIV/AIDS epidemic's impact on demand for inpatient hospital care in a rural area of South Africa.<bold>Design: </bold>Retrospective analysis of data from general hospital and individual ward admission registers, a tuberculosis program database, and patient case notes.<bold>Setting and Patients: </bold>Patients admitted between 1991 and 1998 to a 450-bed hospital that serves Hlabisa District, South Africa (population approximately 200000), where HIV seroprevalence among antenatal clinic attendees increased from 4% in 1992 to 29% in 1998.<bold>Main Outcome Measures: </bold>Number of admissions to 9 hospital wards, number of clinical AIDS and general medical admissions (both excluding tuberculosis), and number of tuberculosis admissions to adult medical wards during the study period.<bold>Results: </bold>Total hospital admissions increased by 81%, from 6562 in 1991 to 11, 872 in 1998. Adult tuberculosis ward admissions increased by 360%, from 303 to 1393. In 1998, tuberculosis patients accounted for 47% and 30% of adult male and female medical ward admissions, respectively, and for 11 % of total hospital admissions. Nontuberculosis clinical AIDS cases increased 43-fold, accounting for 4% of adult medical admissions in 1997 vs 0.2% in 1991. Tuberculosis and nontuberculosis clinical AIDS cases were the only types of admission to show a clear and consistent upward trend over the period studied. Patterns in other types of admissions varied more and changes were smaller.<bold>Conclusions: </bold>The HIV/AIDS epidemic has had an important impact on demand for adult tuberculosis and general medical care in a rural South African district hospital. If this impact is shown to extend to other rural South African areas, response strategies are urgently needed. [ABSTRACT FROM AUTHOR]