HIV Care Cascade and Linkage to Antiretroviral Therapy Among Hospitalized Adults in Lusaka, Zambia

University of Alabama at Birmingham250 enrolled

Overview

The population of inpatients is large in Zambia; however, because of poor linkages between hospitals and community HIV care, there are few data to analyze their engagement in HIV care before and after hospitalization. The goal of the study is to learn more about Zambian adults who are HIV-infected and get hospitalized. The purpose of this study is to gather formative, preliminary data, to be used in future grant applications to improve linkage and engagement in HIV care in Zambia.

The main objective of this study is to generate preliminary data on the outcomes of Zambian HIV-infected individuals after discharge from University Teaching Hospital (UTH) Internal Medicine wards which can inform development of a linkage intervention. Our central hypothesis is that in Sub-Saharan African settings like Zambia hospitalizations among HIV-infected individuals are driven by suboptimal linkage and initiation of ART following HIV diagnosis. Specific Aims: (a) Characterize the distribution of hospitalized 300 HIV-infected adults across the HIV care continuum. (b) Identify structural, psychosocial, clinic, and medical factors that predict suboptimal linkage to care and ART initiation after 90 days of hospital discharge among HIV-infected Zambians.

Study Type

OBSERVATIONAL

Enrollment

250

Conditions

Hiv

Interventions

Standard of careOTHER

Routine standard of care per Ministry of Health protocol, including blood draws and examinations.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 99 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years or older * HIV-infected as documented in the UTH file * Admitted to Internal Medicine Ward at UTH Exclusion Criteria: * Unable to provide informed consent * Not planning to remain in Lusaka province for 3 months after discharge

Locations (1)

University Teaching Hospital

Lusaka, Zambia

Outcomes

Primary Outcomes

Undetectable HIV viral load at 90 days post-discharge

Numerator is number with HIV RNA \<1000 c/mL tested at 90 days after hospital discharge; denominator is the # enrolled

Time frame: 90 days after hospital discharge

Secondary Outcomes

Proportion of HIV-infected inpatients who are on ART upon admission

Numerator is number who report taking ART up to the time of admission; denominator is the # enrolled

Time frame: Baseline

Mortality rate

Mortality from time of enrollment to 90 days after discharge

Time frame: 90 days after hospital discharge

ART initiation

Proportion not on ART upon admission to hospital who are on ART at 90 days after hospital discharge

Time frame: Baseline and 90 days after hospital discharge

Data from ClinicalTrials.gov

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