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

项目总结 中低收入国家(LMIC)的大多数医院不实行出院计划模式 显示在高收入环境(HICS)，以避免疾病后的不良后果。在没有的情况下 这种综合方案以及艾滋病毒和非传染性疾病双重负担的增加， 艾滋病毒携带者(PWH)住院后的死亡率仍然很高。长期目标是 改善出院程序和联系，以照顾威尔斯亲王和非传染性疾病，并实现两者的双重控制 条件。此R21应用程序的目标是适应基于HICS的过渡期护理模式 (中医药)作为成人出院后干预的靶向使用，感染艾滋病毒和 马拉维的非传染性疾病，并评估调整后的准备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，有一个高 威斯康星和非传染性疾病住院后的死亡率，部分原因是缺乏综合出院- 支持住院后护理的相关干预措施。中医在美国是一种循证模式。 被应用于不同患者群体的临床实践，并在 改善患者出院后的预后。如果根据环境和环境进行调整，此模型将非常有用 LMIC中可用的资源，以及在威尔斯亲王医院和非传染性疾病护理中长期采用的可行性测试。 本研究将探索三个具体目标：1.调整中医药治疗非传染性疾病住院的威斯康星 在马拉维。2.对非传染性疾病患者入院的中医药学进行中试。3.评估可行性， 适应性干预的有效性和可接受性。对于第一个目标，通过深入 采访(IDI)和焦点小组讨论(FGD)与HIV/NCD利益相关者、医院工作人员、患者、 和护理人员，我们将制定适应中医的SOP。对于第二个目标，我们将招收62人 连续住院的HIV感染者和已知至少患有一种常见的HIV-心脏代谢疾病的成年人 共病(高血压急症、心力衰竭或糖尿病)，并提供适应的中医药。对于 第三个目标，使用混合方法，对参与的医院工作人员和患者/护理人员进行FGDS和IDI 在中医药方面，我们将评估为更大规模的研究提供中医药的可行性。我们将描述3个月 出院后的结果，包括重新入院、联系和保留护理、死亡率和双重护理 控制艾滋病毒和非传染性疾病。与试点前招募的历史对照组的比较 阶段将提供关于重新入院和死亡的潜在影响的初步数据。这个项目 创新之处在于，它将对PWH/NCDS从HICS到LMICS的已知过渡护理模式进行调整 利用现有资源避免不良后果。它将加强综合联系，以照顾两者 艾滋病毒/非传染性疾病。这项拟议的研究意义重大，因为它代表了弥合差距的新努力 在住院和以社区为基础的护理之间建立联系，并将艾滋病毒/非传染性疾病的防治工作结合起来。

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.