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

项目总结/摘要 这是一份对当前NIH R34申请的行政补充申请， 受COVID-19（C19）大流行影响。父母奖的重点是撒哈拉以南非洲地区与艾滋病毒有关的死亡率， 非洲作为背景，抗逆转录病毒疗法在撒哈拉以南非洲的艾滋病毒治疗中得到了大力推广; 然而，与艾滋病毒有关死亡率仍然高得令人无法接受。这往往反映在艾滋病毒的高流行率上 在南非和东非的住院病人中。艾滋病毒感染者住院面临高住院率 死亡率（10-25%），但最近人们认识到，出院后，死亡率 仍然高达25- 40%。总的来说，在住院治疗的6个月内，大约一半的艾滋病毒感染者 死亡，使得在住院时提供干预措施变得重要。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， 考虑住院设置。此外，住院环境对提供基于证据的艾滋病毒治疗提出了独特的挑战 包括先进的艾滋病毒一揽子护理措施。在本R34中，我们（目标1）开发了一种方法， 向住院的艾滋病毒感染者提供先进的艾滋病毒疾病实验室包，并（目标2）我们进行了 与住院临床医生进行定性研究，了解他们对提供扩大住院治疗的观点 艾滋病毒护理。由于C19大流行，这不成比例地影响了我们计划的住院环境 由于本研究和一般受抑制的人类受试者研究，我们不期望在本研究期间完成目标3， 3-R34年。虽然我们将有一些资源用于无成本的扩展，但这些资源不足以进行试点 并评估这个项目的核心干预措施。使用行政补充，我们将招募一名 暴露于我们干预措施的队列，包括3个组成部分：（a）临床医生对晚期HIV的培训 疾病护理，（B）实验室方法，使CD 4、HIV病毒载量和其他感染测试在治疗期间可用， 住院病人的住院时间，以及（c）病人导航，以加强样品运输、结果返回、临床医生的行动 在这方面，我们将继续努力取得成果，与门诊诊所的艾滋病毒服务挂钩，以及全面实施住院治疗。我们将 然后评估结果，包括晚期艾滋病一揽子护理的住院实施情况， 出院后再入院、死亡率和HIV病毒载量抑制。结果将比较 干预组和观察组。我们还将进行定性访谈和焦点小组讨论， 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.