Evaluation of a hospital-based clinical surveillance system for AIDS in Kinshasa, Zaire.

Kinshasa is the most populous urban area in central Africa. 2.8-8% of the citys estimated population of 3.5 million is infected with HIV. Mama Yemo Hospital is Kinshasas largest public hospital. It has 2000 beds 34% of all hospital beds in the city. The Department of Internal Medicine has 209 beds and hospitalizes all adult medical admissions to the hospital. The wards bed occupation rate however has been over 100% since 1985 and in 1989 almost 4400 patients were admitted. Between January 1986 and late 1988 HIV seroprevalence among adult medical inpatients ranged 34-50% 51-55% of whom had AIDS according to World Health Organization (WHO) criteria. The authors evaluated active surveillance for AIDS among adult medical admissions at Mama Yemo Hospital to assess the feasibility of sentinel surveillance for AIDS. Between February 1 and October 31 1989 all adult medical admissions were interviewed and examined by one of three specially trained nurses. A surveillance card with entries corresponding to the criteria of the WHO clinical case definition for AIDS was completed for each patient. HIV-1 serology was conducted in 369 consecutive patients for use in evaluation of the surveillance system. 853 of 3142 admissions had AIDS as well as 191 of the 369 consecutive patients tested to assess the sensitivity and specificity of the case definition of AIDS. The case definition used by the nurses was 42.6% sensitive and 97.2% specific for HIV-1 seropositivity similar to the sensitivities and specificities obtained by physicians in the same wards in two previous studies. There was a 3.7% inter-observer variability between physicians and nurses. Coverage of the surveillance system averaged 84.1%. Three full-time nurses and a part-time physician were required to operate the surveillance system with follow-up. Follow-up was inefficient and after Projet SIDA ceased surveillance activities active surveillance could not be sustained. Passive reporting is therefore the only viable sustainable approach to AIDS surveillance under field conditions in Kinshasa hospitals.