The availability of antiretroviral therapy (ART) has markedly reduced HIV-related mortality and morbidity in Africa. Yet HIV remains the leading cause of death among adult men and women in South Africa due failure to initiate ART or remain in care. South Africa has approximately 7.1 million people with HIV; 8-13% experience hospitalization at one of the 85,000 public hospital beds in South Africa. Approximately 26% of this hospitalized group dies within 6 months of hospital discharge representing as much as 50% of the 110,000 excess HIV-related deaths in South Africa may be occurring during the post-hospital period. Preliminary work completed by the study team among 122 participants discharged from a single hospital has identified a failure to remain connected with care following hospital discharge as a factor associated with mortality and readmission. This team has also explored barriers to care, including challenges with traveling to care during the period of convalescence, long queue times, and frequent return visits all adding the burden of treatment. This project seeks to test whether overcoming these challenges by bringing care and psychosocial counseling to the convalescing individual can overcome barriers to sustained engagement in care following discharge and reduce post- hospital mortality. We hypothesize that by overcoming structural and psychosocial barriers to care continuity post-hospital mortality will be reduced. The current proposal will allow for the development and piloting of this household clinical visits, or Home Link, strategy to improve post-hospital care and to increase knowledge regarding care engagement during this vulnerable period and to prepare for a randomized clinical trial of the Home Link intervention powered for an efficacy outcome of mortality 6 months after hospital discharge.
HIV remains the leading cause of death in South Africa as a result of a failure of people living with HIV to initiate HIV treatment or to be retained in care. Hospital admission presents an opportunity to engage a population at high risk of mortality in long-term outpatient care; at present post-hospital mortality is high accounting for as much as 50% of HIV-associated mortality in South Africa. The goal of this research is to reduce HIV-associated mortality by developing an actionable approach using home-based care and psychosocial support to retain individuals in HIV care following hospital discharge.
