Reducing HIV-associated post-hospital mortality through home-based care in South Africa: a randomized controlled trial

Authors

Christopher J. Hoffmann, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA.
Kate Shearer, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA.
Boitumelo Kekana, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Deanna Kerrigan, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Tumelo Moloantoa, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Jonathan E. Golub, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA.
Ebrahim Variava, Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, North West Department of Health, Klerksdorp, South Africa.
Neil A. Martinson, Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

12-5-2023

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

DOI

10.1093/cid/ciad727

Keywords

Africa; HIV; advanced HIV disease; hospital discharge; mortality; nutritional intervention; psychosocial intervention

Abstract

BACKGROUND: Twenty-three percent of people with HIV (PWH) die within 6-months of hospital discharge. We tested the hypothesis whether a series of structured home visits could reduce mortality. METHODS: We designed a disease neutral home visit package with up to 6 home visits starting 1-week post-hospitalization and every 2 weeks thereafter. The home visit team used a structured assessment algorithm to evaluate and triage social and medical needs of the participant and provide nutritional support. We compared all-cause mortality 6-months following discharge for the intervention compared to usual care in a pilot randomized trial conducted in South Africa. To inform potential scale-up we also included and separately analyzed a group of people without HIV (PWOH). RESULTS: We enrolled 125 people with HIV and randomized them 1:1 to the home visit intervention or usual care. Fourteen were late exclusions because of death prior to discharge or delayed discharge leaving 111 for analysis. The median age was 39 years, 31% were men; and 70% had advanced HIV disease. At six months among PWH 4 (7.3%) in the home visit arm and 10 (17.9%) in the usual care arm (p = 0.09) had died. Among the 70 PWOH enrolled overall 6-month mortality was 10.1%. Of those in the home visit arm, 91% received at least one home visit. CONCLUSIONS: We demonstrated feasibility of delivering post-hospital home visits and demonstrated preliminary efficacy among PWH with a substantial, but not statistically significant, effect size (59% reduction in mortality). COVID-19 related challenges resulted in under-enrollment.

APA Citation

Hoffmann, Christopher J.; Shearer, Kate; Kekana, Boitumelo; Kerrigan, Deanna; Moloantoa, Tumelo; Golub, Jonathan E.; Variava, Ebrahim; and Martinson, Neil A., "Reducing HIV-associated post-hospital mortality through home-based care in South Africa: a randomized controlled trial" (2023). GW Authored Works. Paper 4005.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4005

Department

Prevention and Community Health