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Feasibility of an integrated intervention to reduce advanced HIV disease mortality among hospitalized adults in Zambia

Award Number: R34MH121103
ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY/ABSTRACT HIV prevalence remains high in inpatient settings in sub-Saharan Africa (SSA) despite robust scale-up of antiretroviral therapy. While HIV-related mortality during hospitalization is high (10-25%), mortality in the 6 months after discharge is even higher (20-40% in several cohort studies), with many deaths resulting from tuberculosis (TB) and Cryptococcal coinfection. Therefore, interventions to optimize the care of advanced HIV disease (i.e., CD4 <200 or WHO clinical stage 3 or 4 conditions) during hospitalization could have a substantial impact on overall HIV-related mortality. In a prospective cohort of HIV-infected adults admitted to the hospital in Zambia, failure to diagnose and treat coinfections during the hospital admission was due to (1) delays in obtaining CD4 count results and additional screening tests for disseminated TB and Cryptococcus and (2) provider misconceptions of the urgency of providing HIV care in inpatient settings. Building on these results and our experience implementing HIV interventions and training clinicians in Zambia, we now propose a multi- component intervention to reduce post-hospital mortality, based on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) framework. The intervention consists of (a) a package of point-of-care (POC) laboratory tests (such as CD4, urine TB LAM antigen, Cryptococcal antigen, and HIV viral load) to enable clinicians to treat coinfections during admission, (b) targeted knowledge transfer to clinicians regarding best practices for advanced HIV disease to predispose them to treat coinfections, and (c) feedback reporting about post-discharge outcomes to inpatient staff to reinforce the approach. In Aim 1, we will develop the POC laboratory package and related standard operating procedures with input from key informants. In Aim 2, to inform the clinician training component, we will conduct focus group discussions with clinicians to explore perspectives and beliefs of the urgency and potential impact of providing interventions for advanced HIV disease during admission. In Aim 3, we will pilot-test the intervention and evaluate feasibility and impact on clinician practice. We will compare treatment of coinfections during the intervention with historical control data. This study will lead to a better understanding of how to deliver advanced HIV disease interventions during hospitalization. It will also assess the potential of a theory- based intervention to reduce post-discharge mortality among HIV-infected individuals in SSA.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $126,002 )
2023	2023	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Mental Health Research Grants	001	3	5/10/2023	SUPPLEMENT FOR EXPANSION	$126,002
2023	2021	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Mental Health Research Grants	000	3	5/9/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $126,002

Issue Date FY: 2021 ( Subtotal = $132,759 )
2021	2021	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Mental Health Research Grants	000	3	6/16/2021	NON-COMPETING CONTINUATION	$132,759
														Subtotal = $132,759

Issue Date FY: 2020 ( Subtotal = $258,725 )
2020	2020	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Mental Health Research Grants	000	2	6/29/2020	NON-COMPETING CONTINUATION	$258,725
														Subtotal = $258,725

Issue Date FY: 2019 ( Subtotal = $208,532 )
2019	2019	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH ST	BIRMINGHAM	AL	35294	JEFFERSON	USA	Mental Health Research Grants	000	1	8/15/2019	NEW	$208,532
														Subtotal = $208,532

Grand Total All Awards = $726,018

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Feasibility of an integrated intervention to reduce advanced HIV disease mortality among hospitalized adults in Zambia

Award Number: R34MH121103

ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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