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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Hiv

Intervention / Treatment
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* Other: Standard of care


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| HIV+ patients (Standard of care)<br>300 HIV-infected and hospitalized adult patients at the University Teaching Hospital (UTH) will be recruited. | Other: Standard of care<br>* Routine standard of care per Ministry of Health protocol, including blood draws and examinations.<br>|
| Health systems informants<br>15 key Zambian health systems informants and leaders who can discuss inpatient care and the process of linking hospitalized patients to HIV care. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 90 days after hospital discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | Baseline | 
| Mortality rate | Mortality from time of enrollment to 90 days after discharge | 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 | Baseline and 90 days after hospital discharge |