The benefits of antiretroviral therapy (ART) can only be achieved through timely HIV diagnosis, successful linkage to care, and treatment initiation. In South Africa, however, only a fraction of those newly diagnosed with HIV enter HIV care. The period after HIV testing but prior to ART initiation represents a time of very high mortality, fueled by the tuberculosis (TB) epidemic, and therefore a time when improving access to TB screening and HIV care would be of substantial benefit. Though TB is the leading cause death among those with HIV in sub-Saharan Africa, less than one-third of HIV-infected South Africans have been screened for TB. Efforts are urgently needed to implement and evaluate strategies that improve early diagnosis and linkage to HIV and TB care, and to consider such strategies in the context of constrained healthcare resources. We propose two specific aims.
The first aim i s to conduct a randomized controlled trial to establish the efficacy of a health system navigator intervention in improving linkage to HIV and TB care among newly diagnosed HIV-infected outpatients in Durban, South Africa. Using Andersen's model of health service utilization as a theoretical framework, we will provide a health system navigator to help patients identify and overcome barriers to care and we will examine the intersection of contextual and patient-level factors that affect linkage to care.
The second aim i s to evaluate the cost and cost-effectiveness of this intervention for promoting linkage to HIV and TB care at the time of HIV screening. The 2010 Trans-NIH Plan for HIV-related research prioritizes the assessment of outcomes related to TB and HIV care integration on survival, quality of care, and cost, as well as the impact of different approaches for testing, linkage, and retention in care in improving outcomes of HIV disease. The proposed study will address several of these important issues through collaboration among medical, behavioral and cost- effectiveness experts working in the US and the South African province with the highest prevalence of HIV and TB. The results will inform HIV and TB care in South Africa and in other resource-limited settings.

Public Health Relevance

The period after a new HIV diagnosis, but prior to starting antiretroviral therapy, is a time of very high mortality for patients in South Africa, and therefore a time when improving access to HIV care would be of substantial benefit. We propose to study the impact and cost-effectiveness of an intervention to improve linkage to HIV and TB care for newly diagnosed HIV-infected people in Durban, South Africa.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH090326-04
Application #
8414167
Study Section
Special Emphasis Panel (ZRG1-AARR-F (08))
Program Officer
Stirratt, Michael J
Project Start
2010-05-01
Project End
2015-01-31
Budget Start
2013-02-01
Budget End
2014-01-31
Support Year
4
Fiscal Year
2013
Total Cost
$501,859
Indirect Cost
$62,312
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Bassett, Ingrid Valerie; Huang, Mingshu; Cloete, Christie et al. (2018) Assessing the completeness and accuracy of South African National Laboratory CD4 and viral load data: a cross-sectional study. BMJ Open 8:e021506
Kubiak, R W; Herbeck, J T; Coleman, S M et al. (2018) Urinary LAM grade, culture positivity, and mortality among HIV-infected South African out-patients. Int J Tuberc Lung Dis 22:1366-1373
Ramirez-Avila, Lynn; Regan, Susan; Cloete, Christie et al. (2017) Adolescent Linkage to Care After a Large-scale Transfer From a Hospital-based HIV Clinic to the Public Sector in South Africa. Pediatr Infect Dis J 36:311-313
Bassett, Ingrid V; Coleman, Sharon M; Giddy, Janet et al. (2017) Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa. J Acquir Immune Defic Syndr 74:432-438
Ahonkhai, Aimalohi A; Adeola, Juliet; Banigbe, Bolanle et al. (2017) Impact of Unplanned Care Interruption on CD4 Response Early After ART Initiation in a Nigerian Cohort. J Int Assoc Provid AIDS Care 16:98-104
Drain, Paul K; Losina, Elena; Coleman, Sharon M et al. (2017) Clinic-Based Urinary Lipoarabinomannan as a Biomarker of Clinical Disease Severity and Mortality Among Antiretroviral Therapy-Naive Human Immunodeficiency Virus-Infected Adults in South Africa. Open Forum Infect Dis 4:ofx167
Siedner, Mark J; Bassett, Ingrid V; Katz, Ingrid T et al. (2016) Reply to Okatch et al. Clin Infect Dis 62:670-1
Bassett, Ingrid V; Coleman, Sharon M; Giddy, Janet et al. (2016) Sizanani: A Randomized Trial of Health System Navigators to Improve Linkage to HIV and TB Care in South Africa. J Acquir Immune Defic Syndr 73:154-60
Drain, Paul K; Losina, Elena; Coleman, Sharon M et al. (2016) Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis. BMC Pulm Med 16:147
Ahonkhai, Aimalohi A; Banigbe, Bolanle; Adeola, Juliet et al. (2016) Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria. J Adolesc Health 59:298-304

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