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| Name | Class |
|---|---|
| University Teaching Hospital | UNKNOWN |
| Centre for Infectious Disease Research in Zambia | OTHER |
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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| HIV+ patients (Standard of care) | 300 HIV-infected and hospitalized adult patients at the University Teaching Hospital (UTH) will be recruited. |
| |
| Health systems informants | 15 key Zambian health systems informants and leaders who can discuss inpatient care and the process of linking hospitalized patients to HIV care. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard of care | Other | Routine standard of care per Ministry of Health protocol, including blood draws and examinations. |
|
| 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 |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
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In part 1, people will be recruited in a random fashion from HIV-infected patients hospitalized at the University Teaching Hospital (UTH) as documented in their UTH medical file regardless of their HIV treatment status. The bed spaces in the wards will be enumerated and using a random number generator the team will select patients for screening for study inclusion.
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| Name | Affiliation | Role |
|---|---|---|
| Michael J Vinikoor, MD | University of Alabama at Birmingham | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Teaching Hospital | Lusaka | Zambia |
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| ID | Term |
|---|---|
| D000163 | Acquired Immunodeficiency Syndrome |
| ID | Term |
|---|---|
| D015658 | HIV Infections |
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
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| ID | Term |
|---|---|
| D059039 | Standard of Care |
| ID | Term |
|---|---|
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
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Blood will be drawn via phlebotomy for patients for whom CD4 and HIV viral load results are not available at baseline. For participants that have initiated ART treatment, we will collect a dried blood spot card using 5 drops of blood from finger prick to measure viral load 90 days after discharge.
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 |
| D015229 |
| Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D012897 | Slow Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |