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

项目总结/文摘

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.