Table 1 Definitions and categorization of clinical diagnoses amongst hospitalized PLHIV at Kiruddu hospital

Tuberculosis

• Active disease considered when either of criteria was met:

 i. Bacteriologic confirmation of TB disease e.g., positive urine LAM, microscopy or GeneXpert

 ii. Clinical diagnoses made by an infectious disease consultant.

 iii. Patient taking anti-TB medication at the time of admission.

Cryptococcal disease

• Considered when either meningeal or non-meningeal disease forms were confirmed by positive cryptococcal antigen test or microscopy.

Candidiasis

• Either oral or oesophageal disease forms were considered, when diagnosed by clinical team

Toxoplasmosis

• Considered when diagnosed by clinical team based on radiologic and serologic evidence of toxoplasma infection.

Kaposi sarcoma

• Considered based on histopathologic diagnosis

COVID-19

• Considered when confirmed by a polymerase chain reaction test or rapid antigen diagnostic test

Co-infection

• Any diagnosis of an “infection” that excluded TB, cryptococcal disease, candidiasis, toxoplasmosis, and COVID-19.

• Examples included diagnoses of respiratory tract infections (e.g., pneumonia), malaria, meningitis (bacterial, viral, or other), gastrointestinal infections, acute viral hepatitis infections, urine tract infections, skin infections, bloodstream infections and sepsis.

Cardiovascular disease

• Included diagnoses involving the cardiovascular system.

• Examples included hypertension (patient with systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or when patient was on anti-hypertensive medication); any cardiac disease confirmed by cardiologist or echocardiography or other cardiac investigations; peripheral artery disease, heart failure, cerebrovascular accidents (stroke), and venous thromboembolism.

Malnutrition

• Considered where undernutrition was confirmed by anthropometric measurement (e.g., mid-upper arm circumference ≤ 22 mm or body mass index ≤ 18.5 kg/m²), or clinical evidence of wasting.

Anaemia

• Considered when measured haemoglobin concentration was < 12.9 g/dl in males or < 11.9 g/dl in females.

Diabetes Mellitus

• Considered when there was confirmed glycated haemoglobin ≥ 6.5% or random blood sugar ≥ 11mmol/L in the presence of symptoms of diabetes or when the patient was taking anti-diabetic medication at the time of admission.

Kidney disease

• Considered when there was evidence of elevated serum creatinine > 105µmol/L or urine output < 0.5 millilitres per kilogram bodyweight per hour, and a diagnosis of either acute kidney injury or chronic kidney disease made by clinical team.

Liver disease

• Considered where there was evidence of chronic viral hepatitis or chronic liver disease (e.g., cirrhosis or fibrosis), drug induced hepatitis or other forms of non-infectious hepatitis, liver failure or other forms of liver disease as determined by the clinical team.

Neurologic disorders

• Considered where diagnoses of epilepsy, seizure disorders or mental/psychiatric disorders were made following the exclusion of CNS infections.

Chronic lung disease

• Considered where a diagnosis of asthma, chronic obstructive pulmonary disease, interstitial lung disease, sequelae of post-TB infections in the absence of active TB disease, or other causes of chronic pulmonary disease, was made.

Cancers

• Considered where there was histopathologic confirmation of an oncologic diagnosis (excluding Kaposi sarcoma) or when the patient was on cancer therapy.