Re-engagement at Discharge (Re-Charge): Improving post-hospital outcomes for HIV-infected adults in Zambia

出院时重新参与（重新充电）：改善赞比亚艾滋病毒感染成人的出院后结果

• 批准号: 10556334
• 负责人: Cassidy W. Claassen
• 金额: $ 22.65万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10556334
• 关键词: Address; Adherence; Adult; Africa South of the Sahara; African; Ambulatory Care Facilities; Behavioral; Caregivers; Caring; Cells; Charge; Clinical; Clinical Research; Clinical Trials; Communities; Community Health; Community Health Aides; Continuity of Patient Care; Cost Analysis; Country; Data; Development; Electronics; Enrollment; Evaluation; Focus Groups; Future; Grant; HIV; HIV antiretroviral; Health Personnel; Health system; Home visitation; Hospital Mortality; Hospitalization; Hospitals; Individual; Inpatients; Intervention; Interview; Manuals; Methods; Modeling; NIH Office of AIDS Research; Outcome; Participant; Patients; Persons; Policy Maker; Population; Practical Robust Implementation and Sustainability Model; Procedures; Program Evaluation; Qualitative Methods; Randomized; Recording of previous events; Records; Research; Sampling; Side; System; Teaching Hospitals; Testing; Time; Training; Translating; Universities; Viral; Zambia; acceptability and feasibility; antiretroviral therapy; barrier to care; comparison group; effectiveness evaluation; epidemic response; evidence base; experience; follow-up; functional status; implementation framework; implementation science; improved; informant; innovation; inpatient service; medication compliance; mortality; multidisciplinary; neglect; novel strategies; outreach; patient engagement; patient retention; pilot test; pregnant; primary outcome; programs; social factors; standard of care; structural determinants; system-level barriers; systems research; trial planning; virtual

PROJECT SUMMARY In sub-Saharan African countries, HIV-infected patients suffer high rates of loss-to-follow-up and mortality following hospital admission. Among HIV-infected patients at University Teaching Hospital (UTH) in Lusaka, Zambia, we found 21% mortality three months after hospital discharge. Novel approaches are needed to re- engage hospitalized patients in ART via the `side door' of the HIV care continuum. The Re-engagement at Discharge (Re-Charge) study aims to understand and characterize the challenges of re-engagement in HIV care following hospital discharge; to adapt an established intervention called Community HIV Epidemic Control (CHEC) to support patients after discharge; and to test the discharge `d-CHEC' intervention to gain preliminary data and experience for a future trial. CHEC is an evidence-based and PEPFAR-supported intervention that utilizes community health workers (CHWs) to improve the HIV care continuum by addressing patient- and system-level barriers, which we will adapt using the PRISM framework to improve post-hospitalization outcomes. This clinical trial planning grant includes 3 Aims: in Aim 1, we will use qualitative methods to better understand barriers to HIV care that arise after hospital discharge in Zambia. We will conduct in-depth interviews and focus group discussions with patients, their caregivers, CHWs, clinicians, and other Zambian health system stakeholders to understand the patient- and system-level obstacles to health care re-engagement following hospital discharge and identify modifiable barriers to care that may be addressed by adaptations to CHEC. In Aim 2, we will translate the findings from Aim 1 to adapt the CHEC model to improve patient retention in care and viral suppression in the post-discharge period. In addition to program components identified in Aim 1, we anticipate the adapted intervention may require: (a) early engagement with the CHEC team before discharge; (b) an electronic discharge summary to facilitate flow of patient information from hospital to the outpatient clinic; and (c) an early post-discharge home visit from a CHW. In Aim 3, the adapted d-CHEC will be pilot-tested and evaluated in a pre/post trial. We will enroll a representative group of HIV-infected adult inpatients at UTH before and after d-CHEC implementation, who will then be followed 6 months after discharge. Outcomes to be assessed include retention in care at 6 months, viral suppression, and mortality. Using mixed methods, we will evaluate the feasibility and acceptability of the adapted d-CHEC intervention from multiple perspectives including patients, caregivers and health care workers. The results will inform a fully-powered cluster-randomized R01 trial to evaluate effectiveness and costs of the d-CHEC model. The project is significant as hospitalization is common among HIV-infected individuals, and innovative as effective discharge interventions are lacking in sub-Saharan Africa. We are well prepared to implement this R34 due to our strong understanding of the Zambian HIV health system and track record in large- scale HIV programs, with expertise in clinical, qualitative, implementation science, and health systems research.

项目概要 在撒哈拉以南非洲国家，艾滋病毒感染者的失访率和死亡率很高 入院后。在卢萨卡大学教学医院 (UTH) 的艾滋病毒感染患者中， 在赞比亚，我们发现出院三个月后死亡率为 21%。需要新的方法来重新 通过艾滋病毒护理连续体的“侧门”让住院患者参与抗逆转录病毒治疗。重新订婚于 出院（重新充电）研究旨在了解和描述重新参与艾滋病毒感染的挑战 出院后的护理；调整一项名为“社区艾滋病毒流行控制”的既定干预措施 (CHEC) 为出院后的患者提供支持；并测试放电“d-CHEC”干预以获得初步结果 为将来的试验提供数据和经验。 CHEC 是一项基于证据且得到 PEPFAR 支持的干预措施， 利用社区卫生工作者 (CHW) 通过解决患者和患者的问题来改善艾滋病毒护理连续性 系统级障碍，我们将使用 PRISM 框架进行调整，以改善出院后的结果。 本次临床试验规划资助包括3个目标：在目标1中，我们将使用定性方法更好地 了解赞比亚出院后出现的艾滋病毒护理障碍。我们将深入开展 与患者、其护理人员、社区卫生工作者、临床医生和其他赞比亚人进行访谈和焦点小组讨论 卫生系统利益相关者了解患者和系统层面的医疗保健重新参与障碍 出院后并确定可以通过适应来解决的可改变的护理障碍 检查。在目标 2 中，我们将转化目标 1 的研究结果，以适应 CHEC 模型，以改善患者的健康状况 出院后的保留护理和病毒抑制。除了程序组件之外 在目标 1 中确定的情况下，我们预计调整后的干预措施可能需要： (a) 尽早与 CHEC 接触 出院前的团队； (b) 电子出院摘要，以促进患者信息从医院的流动 到门诊诊所； (c) 社区卫生工作者出院后尽早家访。在目标 3 中，改编后的 d-CHEC 将在试验前/试验后进行试点测试和评估。我们将招募具有代表性的艾滋病病毒感染者群体 d-CHEC 实施前后在 UTH 住院的成年患者，将在实施后 6 个月进行随访 释放。待评估的结果包括 6 个月的护理保留、病毒抑制和死亡率。 使用混合方法，我们将评估改编后的 d-CHEC 干预措施的可行性和可接受性 包括患者、护理人员和医护人员在内的多个视角。 结果将为全功能集群随机 R01 试验提供信息，以评估以下方法的有效性和成本： d-CHEC 模型。该项目意义重大，因为艾滋病毒感染者住院治疗很常见，并且 撒哈拉以南非洲地区缺乏创新有效的出院干预措施。我们已做好充分准备 实施此 R34 是因为我们对赞比亚艾滋病毒卫生系统有深入的了解，并且在大型项目中取得了良好的记录。 规模艾滋病毒项目，拥有临床、定性、实施科学和卫生系统研究方面的专业知识。

项目成果

Advanced HIV disease management practices within inpatient medicine units at a referral hospital in Zambia: a retrospective chart review.

赞比亚一家转诊医院住院医疗单位的先进艾滋病毒疾病管理实践：回顾性图表审查。

• 发表时间: 2022-02-22
• 作者: Mbewe, Nyuma;Vinikoor, Michael J;Fwoloshi, Sombo;Mwitumwa, Mundia;Lakhi, Shabir;Sivile, Suilanji;Yavatkar, Mallika;Lindsay, Brianna;Stafford, Kristen;Hachaambwa, Lottie;Mulenga, Lloyd;Claassen, Cassidy W
• 通讯作者: Claassen, Cassidy W