Feasibility of an integrated intervention to reduce advanced HIV disease mortality among hospitalized adults in Zambia

项目摘要/摘要 这是对当前NIH R34应用程序的管理补充申请，该申请严重 受新冠肺炎(C19)大流行影响。家长奖的重点是撒哈拉以南地区与艾滋病毒相关的死亡率 非洲。作为背景，抗逆转录病毒疗法(ART)在SSA已被大力推广用于艾滋病毒治疗； 然而，与艾滋病毒相关的死亡率仍然高得令人无法接受。这通常反映在艾滋病毒的高流行率上。 在南部和东部非洲住院的人中。住院的艾滋病毒感染者面临高住院率 死亡率(10%-25%)，但最近人们认识到，出院后死亡率 保持在25%-40%的非常高的水平。总体而言，在住院后的6个月内，大约一半的艾滋病毒携带者 死亡，使得在住院时能够提供的干预措施变得重要。不幸的是，大多数艺术 计划是在门诊环境和/或社区中设计和实施的，而不是 考虑一下住院设置。此外，住院环境对提供循证艾滋病毒构成了独特的挑战 干预措施，包括先进的艾滋病毒护理一揽子计划。在R34中，我们(目标1)开发了一种方法来 向住院的艾滋病毒携带者和(目标2)提供先进的艾滋病毒疾病实验室包 与住院临床医生进行定性研究，以了解他们对扩大住院人数的看法 爱滋病护理。因为C19大流行，它对我们计划的住院环境产生了不成比例的影响 这项研究，总体上抑制了人类受试者的研究，我们预计在此期间不会完成目标3 3年R34。虽然我们将有一些资源用于免费扩展，但它们不足以进行试点 并评估作为该项目核心的干预措施。使用管理补充，我们将注册一个 接受我们干预的队列，由3部分组成：(A)关于高级艾滋病毒的临床医生培训 疾病护理，(B)采取实验室方法，使CD4、艾滋病毒病毒载量和其他感染检测在 住院时间，以及(C)病人导航，以加强样本运输、结果返回、临床医生行动 关于结果，与门诊艾滋病毒服务的联系，以及全面实施住院护理。我们会 然后评估结果，包括住院患者实施先进的艾滋病毒疾病一揽子护理方案，以及 出院后再次入院、死亡率和艾滋病毒载量抑制。结果将在以下两个方面进行比较 干预和观察队列。我们还将进行定性采访和焦点小组，以 了解干预的可行性和可接受性。

PROJECT SUMMARY/ABSTRACT This is an application for an administrative supplement to a current NIH R34 application that was severely affected by the Covid-19 (C19) pandemic. The parent award focused on HIV-related mortality in sub-Saharan Africa. As background, antiretroviral therapy (ART) has been robustly scaled up for HIV treatment in SSA; however, HIV-related mortality remains unacceptably high. This is often reflected in high prevalence of HIV among people hospitalized in Southern and East Africa. People with HIV who are hospitalized face high inpatient mortality (10-25%), but more recently it was recognized that after hospital discharge from the hospital, mortality remains very high at 25-40%. Overall, within 6 months of a hospitalization, around half of people with HIV have died, making interventions that can be delivered at the time of hospitalization important. Unfortunately, most ART programs were designed and are implemented in the outpatient environment and/or the community and do not consider inpatient settings. Further, inpatient settings pose unique challenges to deliver evidence-based HIV interventions including the advanced HIV care package. In this R34, we have (Aim 1) developed an approach to deliver the advanced HIV disease laboratory package to hospitalized people with HIV and (Aim 2) we conducted qualitative research with inpatient clinicians to understand their perspectives on providing expanded inpatient HIV care. Because of the C19 pandemic, which disproportionately impacted inpatient settings where we planned this study, and inhibited human subjects research in general, we are not expecting to complete Aim 3 during this 3-year R34. While we will have some resources for use in a no cost extension, they will be insufficient to pilot and evaluate the intervention at the heart of this project. Using an administrative supplement, we will enroll a cohort that is exposed to our intervention, comprised of 3 components: (a) clinician training on advanced HIV disease care, (b) laboratory approach to make CD4, HIV viral load, and other tests for infections available during the inpatient stay, and (c) patient navigation to strengthen sample transportation, results return, clinician action on results, linkage to HIV services at the outpatient clinic, and overall implementation of inpatient care. We will then assess outcomes, including inpatient implementation of the advanced HIV disease package of care, and post-discharge re-admission, mortality, and HIV viral load suppression. Outcomes will be compared between the intervention and observational cohorts. We will also conduct qualitative interviews and focus groups to understand the feasibility and acceptability of the intervention.