Reducing Post-Hospital Mortality in HIV-Infected Adults in Tanzania

降低坦桑尼亚艾滋病毒感染成人的院后死亡率

• 批准号: 10405597
• 负责人: Robert N Peck
• 金额: $ 52.63万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-09 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10405597
• 关键词: Address; Adherence; Admission activity; Adult; Africa; African; Ambulatory Care; Behavioral Model; Caring; Cities; Clinic; Clinics and Hospitals; Collaborations; Continuity of Patient Care; Control Groups; Country; Data; Equation; Failure; Goals; Guidelines; HIV; Health; Health Personnel; Home; Hospital Mortality; Hospitalization; Hospitals; Intervention; Interview; Lesion; Life; Link; Medical; Medical center; Modeling; Outcome; Outpatients; Participant; Patients; Persons; Pilot Projects; Primary Health Care; Provider; Publishing; Randomized Clinical Trials; Reporting; Research; Resources; Savings; Self Efficacy; Social Workers; Social support; Survival Rate; Tanzania; Time; Transportation; Unemployment; United States; United States National Institutes of Health; Vulnerable Populations; World Health Organization; base; cost; cost effectiveness; efficacy evaluation; evidence base; group intervention; health belief; health service use; high risk; implementation study; improved; improved outcome; inpatient service; intervention cost; intervention effect; meetings; mortality; mortality risk; pilot test; randomized trial; response; social stigma; standard care; standard of care; ward

ABSTRACT: Hospitalization of HIV-infected adults in Africa is often the last opportunity to initiate and maintain life-saving HIV care. Despite the roll out of ART, HIV remains the most common cause of admission to medical wards in Africa. Our data in Tanzania and other data from Africa indicate that 25-40% of hospitalized HIV- infected adults will die within 1 year of hospital discharge. This high post-hospital mortality is strongly associated with failure to link to primary HIV care after hospital discharge. In collaboration with our Tanzanian partners, we have conducted formative research and have developed a social worker intervention to address this critical gap between hospital and HIV clinic. Utilizing the Gelberg and Andersen Behavioral Model of Health Services Utilization for Vulnerable Population, we identified 8 factors that are associated with poor post-hospital clinic linkage including: unemployment, traditional health beliefs, low self-efficacy, lack of transportation, lack of social support, stigma, low perceived need for HIV care, and physical weakness. Based on these factors, we adapted an evidence-based social worker intervention (ARTAS) which has been effective in improving linkage in the United States. A pilot of the social worker intervention in 31 HIV-infected patients at Bugando Medical Center in Mwanza, Tanzania showed that linkage improved from 63% to 100% and survival from 75% to 90% when compared to historical controls. Based on these pilot data, we propose a randomized clinical trial at the public Bugando Medical Center (BMC) and its associated HIV clinic in Mwanza, Tanzania. Our primary aim is to evaluate the efficacy of the social worker intervention to increase the 1-year survival rate in 500 HIV infected adults consecutively discharged from the Bugando Medical Center. We hypothesize that the one-year survival will be 90% in the intervention group vs. 75% in the standard care group. We will have >80% power to detect this 15% absolute difference in survival at p<0.05. Secondary aims will include: 1) to compare linkage to the HIV clinic and subsequent steps in the HIV care continuum, 2) to validate the Gelberg and Andersen Model, 3) to determine the acceptability of the intervention, and 4) to calculate the incremental cost and cost per life saved. The goal of this proposal is to develop a model of care for hospitalized HIV-infected adults to improve their linkage to outpatient care and post-hospital survival. Improving outcomes for HIV-infected adults could save several hundred thousand lives across Africa each year. After the successful completion of this trial, we will conduct implementation studies with our partners in the Tanzanian Ministry of Health to demonstrate scalability and cost-effectiveness.

摘要：非洲艾滋病毒感染的成年人的住院通常是启动和维护的最后机会 挽救生命的艾滋病毒护理。尽管没有艺术品，但艾滋病毒仍然是医疗入院的最常见原因 非洲的病房。我们在坦桑尼亚的数据以及来自非洲的其他数据表明，住院的HIV 25-40％ 被感染的成年人将在出院后的1年内死亡。这种高院后死亡率强烈 与住院后未能与原发性艾滋病毒护理联系起来。 与我们的坦桑尼亚合作伙伴合作，我们进行了形成性研究，并开发了 社会工作者干预以解决医院和艾滋病毒诊所之间的关键差距。利用盖尔伯格和 安德森（Andersen 与院后诊所联系不佳有关，包括：失业，传统健康信念，低 自我效能感，缺乏交通，缺乏社会支持，污名，对艾滋病毒护理的需求低以及 身体上的弱点。基于这些因素，我们改编了基于证据的社会工作者干预 （ARTA）有效地改善了美国的联系。社会工作者的飞行员 在坦桑尼亚姆万扎的Bugando医疗中心对31例HIV感染患者进行干预表明联系 与历史对照相比，从63％提高到100％，生存率从75％提高到90％。 根据这些试点数据，我们在公共Bubando医疗中心提出了一项随机临床试验 （BMC）及其在坦桑尼亚Mwanza的相关HIV诊所。我们的主要目的是评估 社会工作者干预以提高500名HIV感染成人的1年生存率 从Bugando医疗中心出院。我们假设一年生存率为90％ 干预组为标准护理组的75％。我们将拥有> 80％的功率来检测这15％的绝对功率 p <0.05时的存活率差异。次要目标包括：1）将联系与艾滋病毒诊所进行比较 随后的HIV护理连续性步骤，2）验证Gelberg和Andersen模型，3）确定 干预措施的可接受性，以及4）计算节省的增量成本和成本。 该提案的目的是为住院的艾滋病毒感染的成年人开发一种护理模型，以改善他们的 与门诊护理和院后生存的联系。改善感染HIV的成年人的结果可以节省 每年在非洲生活数十万。成功完成此试验后，我们将 与坦桑尼亚卫生部的合作伙伴一起进行实施研究，以证明可伸缩性 和成本效益。

项目成果

Prior undernutrition and insulin production several years later in Tanzanian adults.

• DOI: 10.1093/ajcn/nqaa438
• 发表时间: 2021-06-01
• 期刊: The American journal of clinical nutrition
• 作者: Filteau S;PrayGod G;Rehman AM;Peck R;Jeremiah K;Krogh-Madsen R;Faurholt-Jepsen D
• 通讯作者: Faurholt-Jepsen D