Opinions of doctors working in South African critical care units regarding unconsented testing and empirical treatment of HIV-positive patients in ICU

Keywords: critical care, anti-retroviral agents, HIV, survey, South Africa

Abstract

Background: There exist a limited number of studies demonstrating the benefit of initiating anti-retroviral agents (ARVs) for the treatment of human immunodeficiency virus (HIV) in the critical care setting. However, there are physiological, practical, and ethical arguments against making HIV testing and initiation of ARVs routine practice.

Methods: A self-administered, cross-sectional survey of healthcare professionals was conducted with data collected using a questionnaire distributed to delegates of the Critical Care Society of South Africa (CCSSA) 2016 Congress, and members of the society.

Results: There were 101 respondents. Eight per cent would not consider testing a critically ill patient for HIV (status previously unknown), largely because they considered this unethical. Sixty-nine per cent would consider commencing ARVs in a patient newly-diagnosed with HIV during an inter-current critical illness. The factor most likely to guide them towards this was severity of illness. In general, the greatest concerns focused around biological/medical issues. However, those clinicians who would not consider initiation of ARVs were more likely than those who would, to be concerned about psychosocial issues.

Conclusion: Although the majority of clinicians would consider initiation of ARVs acutely in critically ill patients, it is apparent that the clinical decision-making around this matter is complex. Advocacy is needed to further clarify relevant ethical and legal dilemmas, and in the interim consultative and collaborative care is encouraged.

The full article is available at https://doi.org/10.36303/SAJAA.2020.26.1.2291

Author Biographies

A K Asghar, University of KwaZulu-Natal

Department of Family Medicine, University of KwaZulu-Natal, South Africa

A M Carpenter, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa

J N Mudali, University of KwaZulu-Natal

Department of Family Medicine, University of KwaZulu-Natal, South Africa

M Reade, University of Queensland

Faculty of Medicine, University of Queensland, Australia

R D Wise, University of KwaZulu-Natal

Discipline of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, South Africa

Published
2020-03-04
Section
Original Research