Adaption of the Transition of Care Model for Post-Discharge HIV-NCD care in Malawi

马拉维出院后艾滋病毒非传染性疾病护理的护理模式转变

• 批准号: 10750007
• 负责人: Cecilia Kanyama
• 金额: $ 19.29万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10750007
• 关键词: Address; Admission activity; Adopted; Adoption; Adult; Africa South of the Sahara; Area; Awareness; Behavioral; Caregivers; Caring; Cessation of life; Clinical; Communities; Community Outreach; Complex; Continuity of Patient Care; Control Groups; Data; Diabetes Mellitus; Discharge Plannings; Disease; Disease Management; Effectiveness; Enrollment; Evaluation; Focus Groups; Goals; HIV; Healthcare Systems; Heart failure; Home; Hospitalization; Hospitals; Hotlines; Human immunodeficiency virus test; Income; Individual; Inflammation; Inpatients; Intervention; Interview; Lead; Length of Stay; Malawi; Mediating; Meta-Analysis; Methods; Modeling; Nurses; Opportunistic Infections; Outcome; Outpatients; Participant; Patient Admission; Patient Care; Patient-Focused Outcomes; Patients; Persons; Pharmacists; Phase; Physician Assistants; Polypharmacy; Preparation; Research; Research Personnel; Resources; Role; Surveys; Viral; Virus; Visit; acceptability and feasibility; adverse outcome; antiretroviral therapy; burden of illness; cardiometabolism; clinical practice; community based care; comorbidity; cost; evidence base; experience; feasibility testing; follow-up; hospital readmission; hypertensive; implementation framework; implementation science; improved; innovation; integrated care; low and middle-income countries; mortality; neglect; outreach program; patient population; pilot test; posthospitalization care; programs; provider communication; readmission risk; recruit; research study

PROJECT SUMMARY Most hospitals in Low Middle-Income countries (LMICS) do not practice the discharge planning models shown in high-income settings (HICS) to avert adverse outcomes posthospitalization. In the absence of such integrated programs and an increment in the double burden of disease of HIV and NCDs, the mortality in people living with HIV(PWH) continues to be high post-hospitalization. The long-term goal is to improve discharge practices and linkage to care for PWH and NCDS and achieve dual control of both conditions. The objective of this R21 application is to adapt the Transitional care Mode based in HICS (TCM) for targeted use as a post-discharge intervention for adults hospitalized with comorbid HIV and NCDs in Malawi and evaluate the feasibility and acceptability of the adapted intervention in preparation for a larger implementation science evaluation. The rationale for the project, is that there is a high mortality post-hospitalization for PWH and NCDS, in part because of the lack of integrated discharge- related interventions to support care post-hospitalization. TCM is an evidence-based model in the U.S. adopted into clinical practice for diverse patient populations and demonstrated effectiveness in improving patient outcomes after discharge. This model can be useful if adapted to the context and resources available in LMICS, and feasibility tested for long-term adoption in the care of PWH and NCDs. This research study will explore three specific aims: 1. Adapt the TCM for PWH hospitalized with NCDs in Malawi. 2. Pilot test the adapted TCM with PWH admitted with NCDs. 3. Evaluate the feasibility, effectiveness and acceptability of the adapted intervention. For the first aim, through in-depth interviews (IDI) and focus groups discussions (FGDs) with HIV/NCD stakeholders, hospital staff, patients, and caregivers, we will develop the SOPs for an adapted TCM. For the second aim, we will enroll 62 consecutive adults hospitalized with HIV and known with at least one common HIV- cardiometabolic comorbidity (hypertensive urgency, heart failure, or diabetes,) and provide the adapted TCM. For the third aim, using mixed methods, FGDs and IDI to hospital staff and patient/caregivers who participated in TCM, we will evaluate the feasibility of providing TCM for a larger study. We will describe 3-month post-discharge outcomes including re-admission, linkages and retention in care, mortality, and dual control of HIV and NCDs. Comparison with a historical control group recruited just prior to the pilot phase will provide preliminary data in regard to potential effects on readmission and death. This project is innovative in that it will adapt a known model of transitional care from HICS to LMICS for PWH/NCDS using existing resources to avert adverse outcomes. It will reinforce integrated linkages to care for both HIV/NCDs. The proposed research is significant because it represents a new effort to bridge the gap between inpatient and community-based care and integrate the care of HIV/NCDs posthospitalization.

项目摘要 中低收入国家（LMICS）的大多数医院不采用出院计划模式 在高收入背景下（HICS），以避免不利的结果后资本化。在没有 这些综合方案以及艾滋病毒和非传染性疾病双重负担的增加， 艾滋病毒感染者住院后的死亡率仍然很高。长期目标是 改善威尔斯亲王医院和非社区复康服务的出院安排和联系，并达致两者的双重管制 条件此R21应用程序的目的是调整基于HICS的过渡期护理模式 (TCM)有针对性地用于患有合并症HIV的住院成人的出院后干预， 马拉维的非传染性疾病，并评估准备中的适应性干预措施的可行性和可接受性 进行更大规模的实施科学评估。该项目的基本原理是， 威尔斯亲王医院及非传染性心脏病院的住院后死亡率，部分原因是缺乏综合出院安排- 相关干预措施，以支持住院后护理。TCM在美国是一种循证医学模式。 在临床实践中用于不同的患者人群，并证明了其有效性， 改善患者出院后的预后。如果根据具体情况加以调整， 资源，并进行可行性测试，以长期采用在照顾威尔斯亲王医院和非传染性疾病。 本研究将探讨三个具体目标：1。中医药在非传染性疾病住院的PWH中的应用 在马拉维。2.对患有非传染性疾病的威尔斯亲王医院进行了适应性中医药的试点测试。3.评估可行性， 适应性干预的有效性和可接受性。第一，通过深入 与艾滋病毒/非传染性疾病利益攸关方、医院工作人员、患者进行访谈（IDI）和焦点小组讨论（FGD）， 和护理人员，我们将为适应性TCM制定SOP。第二个目标，我们将招收62名 连续成年人因艾滋病毒住院，并已知至少有一种常见的艾滋病毒-心脏代谢 合并症（高血压急症、心力衰竭或糖尿病），并提供相应的中医药。为 第三个目标，使用混合方法，FGD和IDI，以医院工作人员和患者/护理人员谁参加 在中医药方面，我们会评估提供中医药作更大型研究的可行性。我们将描述3个月 出院后的结果，包括再入院，联系和保留在照顾，死亡率，和双重 控制艾滋病毒和非传染性疾病。与试验前招募的历史对照组比较 阶段将提供关于对再入院和死亡的潜在影响的初步数据。这个项目 是创新的，因为它将采用一种已知的模式，为威尔斯亲王医院/非传染性疾病提供从HICS到LMICS的过渡性护理 利用现有资源避免不利结果。它将加强综合联系，以兼顾这两个方面 艾滋病毒/非传染性疾病。这项拟议中的研究意义重大，因为它代表了弥合差距的新努力 在住院治疗和社区护理之间进行协调，并整合医院后艾滋病毒/非传染性疾病的护理。