Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study

Peck, Robert; Wang, Richard J.; Mtui, Graham; Smart, Luke R.; Yango, Missana; Elchaki, Rim; Wajanga, Bahati; Downs, Jennifer A.; Mteta, Kien; Fitzgerald, Daniel W.

doi:10.1097/qai.000000000001107

Cited by 13 publications

(25 citation statements)

References 21 publications

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“…Regardless, the combination of high repeat inpatient utilization and failure to successfully follow-up with outpatient care emphasizes the need to develop patient-centered approaches to post-hospital health management [26,27]. While a modest number of deaths and readmissions were captured and the data were largely consistent with previous reports [28–31], we hypothesize that mortality and readmission rates were higher, especially given the large number of participants that were unreachable. The study was limited in that it consisted of a convenience sample, recruited from a single center in the North West province of South Africa.…”

Section: Discussionsupporting

confidence: 64%

Hospitalization and post-discharge care in South Africa: A critical event in the continuum of care

Cichowitz¹,

Pellegrino²,

Motlhaoleng

et al. 2018

PLoS ONE

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ObjectivesThe purpose of this prospective cohort study is to characterize the event of acute hospitalization for people living with and without HIV and describe its impact on the care continuum. This study describes care-seeking behavior prior to an index hospitalization, inpatient HIV testing and diagnosis, discharge instructions, and follow-up care for patients for patients being discharged from a single hospital in South Africa.MethodsA convenience sample of adult patients was recruited from the medical wards of a tertiary care facility. Baseline information at the time of hospital admission, subsequent diagnoses, and discharge instructions were recorded. Participants were prospectively followed with phone calls for six months after hospital discharge. Descriptive analyses were performed.ResultsA total of 293 participants were enrolled in the study. Just under half (46%) of the participants were known to be living with HIV at the time of hospital admission. Most participants (97%) were given a referral for follow-up care; often that appointment was scheduled within two weeks of discharge (64%). Only 36% of participants returned to care within the first month, 50% returned after at least one month had elapsed, and 14% of participants did not return for any follow up.ConclusionsLarge discrepancies were found between the type of post-discharge follow-up care recommended by providers and what patients were able to achieve. The period of time following hospital discharge represents a key transition in care. Additional research is needed to characterize patients’ risk following hospitalization and to develop patient-centered interventions.

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Section: Discussionsupporting

confidence: 64%

Hospitalization and post-discharge care in South Africa: A critical event in the continuum of care

Cichowitz¹,

Pellegrino²,

Motlhaoleng

et al. 2018

PLoS ONE

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“…These findings highlight a population with HIV at particularly high risk of death and add new insight to similar high post-hospital mortality from similar single hospital studies. Studies from South Africa, Tanzania, and Kenya have reported 6 to 12 month mortality ranging between 18 and 50% [5, 9–11, 15].…”

Section: Discussionmentioning

confidence: 99%

“…Reported inpatient mortality for people with HIV in sub-Saharan Africa ranges from 15–45% [6–8], a level of mortality that may persist following hospital discharge. For example, a study from Tanzania reported 50% mortality one year from hospital discharge [9] and studies from South Africa have reported 18–31% mortality six months from discharge [10, 11]. A better understanding of outcomes, and factors associated with poor outcomes may help to identify opportunities to reduce HIV-associated mortality.…”

Section: Introductionmentioning

confidence: 99%

Readmission and death following hospitalization among people with HIV in South Africa

et al. 2019

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Background Additional approaches are needed to identify and provide targeted interventions to populations at continued risk for HIV-associated mortality. We sought to describe care utilization and mortality following an index hospitalization for people with HIV in South Africa. Methods We conducted a prospective cohort study among hospitalized patients admitted to medicine wards at a single hospital serving a large catchment area. Participants were followed to 6 months post-discharge. Hospital records were used to describe overall admission numbers and inpatient mortality. Poisson regression was used to assess for associations between readmission or death and independent variables. Results Of 124 enrolled participants, 121 lived to hospital discharge. At the time of discharge the median length of stay of sampled patients was 5.5 days and 105 (87%) participants were referred for follow-up, most within 2 weeks of discharge. By 6 months post-discharge, only 18% of participants had attended the clinic to which they were referred and within the referred timeframe; 64 (53%) had been readmitted at least once and 31 (26%) had died. Self-reported skipping care due to difficulty in access (relative risk 1.3, p = 0.02) and not attending follow-up care on time or at the scheduled clinic or not attending clinic at all (relative risk 1.8 and 2.4, respectively, p = 0.001) were associated with readmission or mortality. Conclusions The post-hospital period is a period of medical vulnerability and high mortality. Improving post-hospital retention in care may reduce post-hospital mortality.

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“…For example, individuals with nonsuppression of HIV RNA could be identified and further evaluated for virological failure and suboptimal retention [7]. Hospitalization also often precedes death, not just during admission [8] but also during the postdischarge period [9, 10]. Mortality during the 6 months after a hospitalization was 23.2% in Uganda [10] and 42.9% in Tanzania [9], and HIV-infected individuals had 1.54 times the odds of postdischarge mortality compared with uninfected individuals [9].…”

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confidence: 99%

Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia

Haachambwa

Kandiwo

Zulu

et al. 2019

Open Forum Infectious Diseases

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Background We characterized the extent of antiretroviral therapy (ART) experience and postdischarge mortality among hospitalized HIV-infected adults in Zambia. Methods At a central hospital with an opt-out HIV testing program, we enrolled HIV-infected adults (18+ years) admitted to internal medicine using a population-based sampling frame. Critically ill patients were excluded. Participants underwent a questionnaire regarding their HIV care history and CD4 count and viral load (VL) testing. We followed participants to 3 months after discharge. We analyzed prior awareness of HIV-positive status, antiretroviral therapy (ART) use, and VL suppression (VS; <1000 copies/mL). Using Cox proportional hazards regression, we assessed risk factors for mortality. Results Among 1283 adults, HIV status was available for 1132 (88.2%), and 762 (67.3%) were HIV-positive. In the 239 who enrolled, the median age was 36 years, 59.7% were women, and the median CD4 count was 183 cells/mm3. Active tuberculosis or Cryptococcus coinfection was diagnosed in 82 (34.3%); 93.3% reported prior awareness of HIV status, and 86.2% had ever started ART. In the 64.0% with >6 months on ART, 74.4% had VS. The majority (92.5%) were discharged, and by 3 months, 48 (21.7%) had died. Risk of postdischarge mortality increased with decreasing CD4, and there was a trend toward reduced risk in those treated for active tuberculosis. Conclusions Most HIV-related hospitalizations and deaths may now occur among ART-experienced vs -naïve individuals in Zambia. Development and evaluation of inpatient interventions are needed to mitigate the high risk of death in the postdischarge period.

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Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study

Cited by 13 publications

References 21 publications

Hospitalization and post-discharge care in South Africa: A critical event in the continuum of care

Hospitalization and post-discharge care in South Africa: A critical event in the continuum of care

Readmission and death following hospitalization among people with HIV in South Africa

Care Continuum and Postdischarge Outcomes Among HIV-Infected Adults Admitted to the Hospital in Zambia

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