People living with HIV (PLWH) are at high risk of poor health outcomes after being discharged from the hospital. This study is designed to test whether providing structured care at home-either with or without nutritional support-can help reduce the risk of death within six months of discharge and improve long-term health outcomes.

The investigators are conducting a randomized clinical trial to evaluate the effectiveness of home-based care on post-hospital recovery. Participants are randomly assigned to one of three groups: (1) standard post-discharge care, (2) home-based care that includes medical assessments, support for taking HIV medications (adherence support), and psychosocial counseling, or (3) the same home-based care plus food parcels to support nutrition.

This is a three-arm, individually randomized clinical trial and a type-1 hybrid implementation-effectiveness study, which means the investigators are not only testing whether the interventions improve health outcomes, but also examining how the interventions are delivered and whether the interventions are practical and acceptable in real-world settings. The trial begins with a pilot phase to test the investigators enrollment procedures and improve baseline data collection.

In addition to measuring whether the interventions reduce the risk of death, the study will assess how many people receive the intervention, whether it is acceptable to patients and families, and how consistently it is delivered. The investigators are also evaluating the economic impact of illness, hospitalization, and death on households, and analyzing the cost and resource needs of delivering home-based care, with or without food support.

The investigators goal is to provide evidence that can improve care for people living with HIV after hospital discharge. If effective, this approach may be applied more broadly to improve outcomes for other high-risk patients in similar settings. Findings from the study will be used to inform health policy and clinical practice, particularly in areas with limited resources and high HIV burden.

Inclusion Criteria:

• Documented HIV infection (either diagnosed during or prior to hospital admission), consisting of any clinical documentation, including a chart note of HIV positivity, Ritonavir-boosted darunavir (RVD) positivity, or antiretroviral therapy (ART) regimen documentation/prescription
• ≥18 years old as per hospital file or government issued document
• Self-report that the participant resides within Matlosana sub-district
• Admitted to an adult internal medicine ward at Tshepong Hospital
• Have spent at least 2 nights in the hospital prior to recruitment to the trial.
• Agree to post-discharge follow-up, including home visits
• Are able to provide informed consent or if lacking capacity to provide consent at the time of recruitment, as determined by the study team, have a next of kin able to provide informed consent.

Exclusion Criteria:

• Admitted to a non-medical (i.e., surgical, psychiatric, etc.) ward, admitted for elective reasons, or admitted to facilitate onward transfer to another hospital
• Participant or next of kin unable to provide written informed consent in any of the languages of the informed consents or spoken by the study team

De-identified datasets including HIV status, viral load, clinical data, health service use, food security, social support, quality of life, participant health costs, HIV stigma, violence screening, health system trust, and weight measurements. Qualitative interview data will be stored securely and may be shared upon request under restricted access. Data will be date-offset to protect confidentiality.

Data will be available 6 to 24 months after completion of data collection, following cleaning, de-identification, and locking of datasets. Data will be stored and accessible for at least 10 years.

Access will be granted to qualified researchers who submit a data use request to the Principal Investigator and obtain Institutional Review Board (IRB) approval for secondary analyses. Data access will be controlled through a repository (Dryad) that applies an independent review panel. Researchers will access de-identified and date-offset data and associated supporting documents via the repository under controlled conditions designed to protect participant privacy. Qualitative data will be accessed only by request and with restrictions.