A social worker intervention to reduce post-hospital mortality in HIV-infected adults in Tanzania (Daraja): Study protocol for a randomized controlled trial.
A social worker intervention to reduce post-hospital mortality in HIV-infected adults in Tanzania (Daraja): Study protocol for a randomized controlled trial.
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DOI：
10.1016/j.cct.2022.106680
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发表时间：
2022-03
影响因子：
2.2
通讯作者：
Kapiga S
中科院分区：
文献类型：
--
作者：
Kisigo GA;Issarow B;Abel K;Hashim R;Okello ES;Ayieko P;Lee MH;Grosskurth H;Fitzgerald D;Peck RN;Kapiga S
在撒哈拉以南非洲(SSA)，出院后住院的艾滋病毒感染者被证明死亡率极高。Daraja是一种个人水平的、有时间限制的五次病例管理干预措施，旨在将住院的艾滋病毒感染患者在出院时与门诊艾滋病毒护理联系起来。一项随机对照试验将旨在评估Daraja干预措施在降低住院的艾滋病毒感染患者出院时死亡率方面的效果。这项研究将从坦桑尼亚姆万扎地区的医院招募500名天真或拖欠7天的艾滋病毒感染者住院治疗。参与者将在住院期间登记，并将进行基线评估。参与者将随机接受标准护理艾滋病毒联系，或在预期出院日期前一天接受Daraja干预。Daraja干预包括由一名社会工作者在3个月内提供的五次课程。所有参与者将在12个月和24个月完成后续评估。措施将包括一年存活率、艾滋病毒护理连续结果(联系、保留、抗逆转录病毒依从性和病毒抑制)和成本(干预的增量成本和每挽救一条生命的成本)。将收集质量保证数据，并描述干预的可行性和可接受性。统计分析将评估Daraja干预措施在改善存活率和艾滋病毒护理连续成果方面的有效性。由于与初级艾滋病毒护理的联系不佳，出院的艾滋病毒感染住院患者的死亡率较高。Daraja干预措施有可能解决阻碍从医院成功过渡到初级艾滋病毒护理的障碍。临床试验.gov，NCT03858998。注册日期为2019年3月1日。
In sub-Saharan Africa (SSA), hospitalized HIV-infected patients who are discharged home have been shown to experience extremely high mortality rate. Daraja is an individual-level, time-limited, five-session case management intervention aiming to link hospitalized HIV-infected patients to outpatient HIV care upon discharge. A randomized control trial will aim at evaluating the efficacy of Daraja intervention on reducing mortality in hospitalized HIV-infected patients upon discharge from hospital. The study will recruit 500 hospitalized HIV-infected adults who are ART naïve or defaulted for >7 days from hospitals in Mwanza region, Tanzania. Participants will be enrolled during hospitalization and a baseline assessment will be done. Participants will be randomized to receive either the standard of care HIV linkage, or the Daraja intervention a day before the expected hospital discharge date. The Daraja intervention includes five sessions delivered by a social worker over a 3-month period. All participants will complete follow-up assessment at month 12 and 24. Measures will include 1-year survival, HIV care continuum outcomes (linkage, retention, antiretroviral adherence, and viral suppression), and cost (incremental cost of the intervention and cost per life saved). Quality assurance data will be collected, and the feasibility and acceptability of the intervention will be described. Statistical analysis will assess the effectiveness of the Daraja intervention on improving survival and HIV care continuum outcomes. Hospitalized HIV-infected patients who are being discharged home have higher mortality due to poor linkage to primary HIV care. The Daraja intervention has the potential to address barriers that prevent successful transition from hospital to primary HIV care. ClinicalTrials.gov, NCT03858998. Registered on 01 March 2019.
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