Incidence rate of hospital re-admissions within 30 days and associated factors among patients with advanced HIV disease in Uganda: comparison of logistic and count regression models.

Abstract

Introduction: Effective management of persons with Advanced HIV Disease (AHD) is essential to reduce HIV-related readmissions. Readmissions often occur due to AHD complications, impacting healthcare costs and patient satisfaction. Study Objective: To determine the incidence rate of readmission within 30 days post-discharge and associated factors among AHD patients in Uganda, comparing logistic and count regression models. Methods: A retrospective cohort study was conducted at Kiruddu National Referral Hospital, classifying 855 AHD patients by their ART status. The study used secondary data for patients aged ≥12 with AHD, admitted in the period from March 2020 to July 2022, with in-hospital deaths excluded. The performance of the multivariable logistic and count regression models was compared based on BIC values. Statistical significance of predictor variables was determined by p-values <0.05 and 95% Confidence Intervals. Results: Among 855 AHD patients across ART categories (active, defaulted, naïve), the 30-day readmission rate was 6.78 (95% CI: 6.70-6.86) per 100 months of observation. ART-active patients had the highest incidence rate (7.33), then ART-defaulted (5.90), and ART-naive (5.78). AHD patients aged 25-39, 40-49, and 50+ years, active on ART had lower odds of 30-day readmission than those aged 12-24 years, (AOR: 0.12, 95% CI: 0.03-0.43; AOR: 0.08, 95% CI: 0.02-0.37; AOR: 0.14, 95% CI: 0.03-0.63). Patients with candidiasis and/or ≥3 comorbidities were more likely to be readmitted (AOR: 3.65, 95% CI: 1.02-13.04; AOR: 7.02, 95% CI: 1.32-37.48), adjusted for other factors. No significant factors were associated with readmission among ART defaulted and ART-naive patients. Binary logistic regression outperformed count models to predict factors associated with 30-day readmission. Conclusion: This study assessed 30-day readmission incidence rates and factors in AHD patients in Uganda, yielding an overall incidence rate of 6.78 (95% CI: 6.70-6.86) per 100 person months. ART-active patients had the highest rate. Younger age (12-24 years), candidiasis, and ≥3 comorbidities were linked to increased readmission likelihood, notably among ART-active patients. Binary logistic regression performed better in identifying 30-day readmission factors than count models.