Ending AIDS deaths requires improvements in clinical care for people with advanced HIV disease who are seriously ill

Burke, Rachael M; Feasey, Nicholas A.; Rangaraj, Ajay; Camps, Maria Ruano; Meintjes, Graeme; El‐Sadr, Wafaa; Ford, Nathan

doi:10.1016/s2352-3018(23)00109-1

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…Despite successes in expanding the availability of HIV testing and treatment worldwide, people living with HIV still experience high rates of hospitalization, and hospitalized people with HIV continue to have poor outcomes . Improving care for hospitalized people with HIV will be critical for ending AIDS deaths …”

Section: Introductionmentioning

confidence: 99%

Linkage Case Management and Posthospitalization Outcomes in People With HIV

Peck,

Issarow,

Kisigo

et al. 2024

JAMA

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ImportanceDespite the widespread availability of antiretroviral therapy (ART), people with HIV still experience high mortality after hospital admission.ObjectiveTo determine whether a linkage case management intervention (named “Daraja” [“bridge” in Kiswahili]) that was designed to address barriers to HIV care engagement could improve posthospital outcomes.Design, Setting, and ParticipantsSingle-blind, individually randomized clinical trial to evaluate the effectiveness of the Daraja intervention. The study was conducted in 20 hospitals in Northwestern Tanzania. Five hundred people with HIV who were either not treated (ART-naive) or had discontinued ART and were hospitalized for any reason were enrolled between March 2019 and February 2022. Participants were randomly assigned 1:1 to receive either the Daraja intervention or enhanced standard care and were followed up for 12 months through March 2023.InterventionThe Daraja intervention group (n = 250) received up to 5 sessions conducted by a social worker at the hospital, in the home, and in the HIV clinic over a 3-month period. The enhanced standard care group (n = 250) received predischarge HIV counseling and assistance in scheduling an HIV clinic appointment.Main Outcomes and MeasuresThe primary outcome was all-cause mortality at 12 months after enrollment. Secondary outcomes related to HIV clinic attendance, ART use, and viral load suppression were extracted from HIV medical records. Antiretroviral therapy adherence was self-reported and pharmacy records confirmed perfect adherence.ResultsThe mean age was 37 (SD, 12) years, 76.8% were female, 35.0% had CD4 cell counts of less than 100/μL, and 80.4% were ART-naive. Intervention fidelity and uptake were high. A total of 85 participants (17.0%) died (43 in the intervention group; 42 in the enhanced standard care group); mortality did not differ by trial group (17.2% with intervention vs 16.8% with standard care; hazard ratio [HR], 1.01; 95% CI, 0.66-1.55; P = .96). The intervention, compared with enhanced standard care, reduced time to HIV clinic linkage (HR, 1.50; 95% CI, 1.24-1.82; P &lt; .001) and ART initiation (HR, 1.56; 95% CI, 1.28-1.89; P &lt; .001). Intervention participants also achieved higher rates of HIV clinic retention (87.4% vs 76.3%; P = .005), ART adherence (81.1% vs 67.6%; P = .002), and HIV viral load suppression (78.6% vs 67.1%; P = .01) at 12 months. The mean cost of the Daraja intervention was about US $22 per participant including startup costs.Conclusions and RelevanceAmong hospitalized people with HIV, a linkage case management intervention did not reduce 12-month mortality outcomes. These findings may help inform decisions about the potential role of linkage case management among hospitalized people with HIV.Trial RegistrationClinicalTrials.gov Identifier: NCT03858998

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Section: Introductionmentioning

confidence: 99%

Linkage Case Management and Posthospitalization Outcomes in People With HIV

Peck,

Issarow,

Kisigo

et al. 2024

JAMA

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How to DREAMM and end HIV-related deaths

Kanyama,

Phiri,

Matola

et al. 2023

The Lancet Global Health

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Reducing HIV-Associated Post-Hospital Mortality Through Home-Based Care in South Africa: A Randomized Controlled Trial

Hoffmann,

Shearer,

Kekana

et al. 2023

Clinical Infectious Diseases

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Background Twenty-three percent of people with HIV (PWH) die within 6-months of hospital discharge. We tested the hypothesis whether a series of structured home visits could reduce mortality. Methods We designed a disease neutral home visit package with up to 6 home visits starting 1-week post-hospitalization and every 2 weeks thereafter. The home visit team used a structured assessment algorithm to evaluate and triage social and medical needs of the participant and provide nutritional support. We compared all-cause mortality 6-months following discharge for the intervention compared to usual care in a pilot randomized trial conducted in South Africa. To inform potential scale-up we also included and separately analyzed a group of people without HIV (PWOH). Results We enrolled 125 people with HIV and randomized them 1:1 to the home visit intervention or usual care. Fourteen were late exclusions because of death prior to discharge or delayed discharge leaving 111 for analysis. The median age was 39 years, 31% were men; and 70% had advanced HIV disease. At six months among PWH 4 (7.3%) in the home visit arm and 10 (17.9%) in the usual care arm (p = 0.09) had died. Among the 70 PWOH enrolled overall 6-month mortality was 10.1%. Of those in the home visit arm, 91% received at least one home visit. Conclusions We demonstrated feasibility of delivering post-hospital home visits and demonstrated preliminary efficacy among PWH with a substantial, but not statistically significant, effect size (59% reduction in mortality). COVID-19 related challenges resulted in under-enrollment.

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Ending AIDS deaths requires improvements in clinical care for people with advanced HIV disease who are seriously ill

Cited by 3 publications

References 23 publications

Linkage Case Management and Posthospitalization Outcomes in People With HIV

Linkage Case Management and Posthospitalization Outcomes in People With HIV

How to DREAMM and end HIV-related deaths

Reducing HIV-Associated Post-Hospital Mortality Through Home-Based Care in South Africa: A Randomized Controlled Trial

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