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

降低赞比亚住院成人晚期艾滋病毒死亡率的综合干预措施的可行性

• 批准号: 10204985
• 负责人: Michael Jeffrey Vinikoor
• 金额: $ 13.28万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10204985
• 关键词: Address; Adherence; Admission activity; Adult; Affect; Africa South of the Sahara; Ambulatory Care Facilities; Antigens; Area; Attitude; Awareness; Behavior; Belief; Biological Assay; CD4 Lymphocyte Count; Caring; Cessation of life; Characteristics; Clinical; Cohort Studies; Cost Analysis; Cryptococcus; Data; Diagnosis; Disease; Drug Prescriptions; Elements; Enabling Factors; Enrollment; Epidemic; Evaluation; Evidence based treatment; Failure; Feedback; Focus Groups; Future; Guidelines; HIV; Health system; Home; Hospital Administrators; Hospital Mortality; Hospitalization; Hospitals; Human immunodeficiency virus test; Individual; Inpatients; Intervention; Interview; Investigation; Knowledge; Laboratories; Life; Measures; Mentors; Methods; Modeling; NIH Office of AIDS Research; Outcome; Patient Care; Patient Discharge; Patient-Focused Outcomes; Patients; Point of Care Technology; Predisposing Factor; Preparation; Prevalence; Procedures; Professional counselor; Prophylactic treatment; Prospective cohort; Provider; Reinforcing Factor; Reporting; Research; Sampling; System; Test Result; Testing; Training; Tuberculosis; Urine; Viral; Viral Load result; World Health Organization; Zambia; antiretroviral therapy; base; co-infection; cohort; cost; cost effectiveness; design; diagnosis evaluation; evidence base; experience; follow-up; health care delivery; hospital readmission; implementation determinants; implementation science; improved; informant; inpatient service; intervention effect; medical specialties; mortality; multi-component intervention; novel strategies; pill; point of care; point of care testing; sample collection; scale up; screening; theories; treatment comparison

PROJECT SUMMARY/ABSTRACT HIV prevalence remains high in inpatient settings in sub-Saharan Africa (SSA) despite robust scale-up of antiretroviral therapy. While HIV-related mortality during hospitalization is high (10-25%), mortality in the 6 months after discharge is even higher (20-40% in several cohort studies), with many deaths resulting from tuberculosis (TB) and Cryptococcal coinfection. Therefore, interventions to optimize the care of advanced HIV disease (i.e., CD4 <200 or WHO clinical stage 3 or 4 conditions) during hospitalization could have a substantial impact on overall HIV-related mortality. In a prospective cohort of HIV-infected adults admitted to the hospital in Zambia, failure to diagnose and treat coinfections during the hospital admission was due to (1) delays in obtaining CD4 count results and additional screening tests for disseminated TB and Cryptococcus and (2) provider misconceptions of the urgency of providing HIV care in inpatient settings. Building on these results and our experience implementing HIV interventions and training clinicians in Zambia, we now propose a multi- component intervention to reduce post-hospital mortality, based on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) framework. The intervention consists of (a) a package of point-of-care (POC) laboratory tests (such as CD4, urine TB LAM antigen, Cryptococcal antigen, and HIV viral load) to enable clinicians to treat coinfections during admission, (b) targeted knowledge transfer to clinicians regarding best practices for advanced HIV disease to predispose them to treat coinfections, and (c) feedback reporting about post-discharge outcomes to inpatient staff to reinforce the approach. In Aim 1, we will develop the POC laboratory package and related standard operating procedures with input from key informants. In Aim 2, to inform the clinician training component, we will conduct focus group discussions with clinicians to explore perspectives and beliefs of the urgency and potential impact of providing interventions for advanced HIV disease during admission. In Aim 3, we will pilot-test the intervention and evaluate feasibility and impact on clinician practice. We will compare treatment of coinfections during the intervention with historical control data. This study will lead to a better understanding of how to deliver advanced HIV disease interventions during hospitalization. It will also assess the potential of a theory- based intervention to reduce post-discharge mortality among HIV-infected individuals in SSA.

项目摘要/摘要 艾滋病毒的患病率在撒哈拉以南非洲（SSA）的住院环境中仍然很高 抗逆转录病毒疗法。虽然住院期间与HIV相关的死亡率很高（10-25％），但死亡率为6 出院后的几个月甚至更高（在几项队列研究中为20-40％），许多死亡导致 结核病（TB）和隐球菌共感染。因此，以优化高级艾滋病毒的干预措施 疾病（即CD4 <200或WHO WHO临床阶段3或4疾病）在住院期间可能具有很大的 对整体HIV相关死亡率的影响。在预期的艾滋病毒感染的成年人中，被送往医院 在赞比亚，住院期间未能诊断和治疗共同感染是由于（1）延迟 获得CD4计数结果以及散布的TB和加密环球的其他筛选测试，以及（2） 提供者对在住院环境中提供艾滋病毒护理的紧迫性的误解。基于这些结果 以及我们在赞比亚实施HIV干预和培训临床医生的经验 基于易感性，加强和 在教育诊断和评估（之前）框架中启用构造。干预 由（a）一套护理点（POC）实验室测试组成（例如CD4，尿液TB LAM抗原， 隐球菌抗原和HIV病毒负荷）使临床医生能够在入院期间治疗共感染，（b） 有针对性的知识转移到临床医生关于晚期艾滋病毒疾病的最佳实践的转移 他们以治疗共同感染，以及（c）有关住院工作人员的后收费结果的反馈报告 加强方法。在AIM 1中，我们将开发POC实验室包和相关标准操作 关键线人输入的程序。在AIM 2中，为了告知临床医生培训部分，我们将进行 与临床医生进行焦点小组讨论，以探索有关紧迫性和潜在影响的观点和信念 在入院期间提供晚期艾滋病毒疾病的干预措施。在AIM 3中，我们将进行试验测试 干预和评估可行性和对临床医生实践的影响。我们将比较共同感染的处理 在干预历史控制数据期间。这项研究将使人们更好地了解如何 在住院期间提供晚期艾滋病毒疾病干预措施。它还将评估理论的潜力 - 基于SSA中HIV感染的个体中降低病后死亡率的基于干预措施。