April 24, 2024

Enhancing healthcare for hospitalized individuals with HIV in Tanzania

A recent study conducted by researchers at Weill Cornell Medicine has revealed that providing three months of social worker follow-up support to hospitalized individuals with HIV in Tanzania led to health benefits at a low cost. The initiative aimed to expedite participants’ attendance at an HIV clinic and initiation of antiretroviral therapy post-discharge. Although the study, published in JAMA, demonstrated improvements in prompt clinic visits and therapy initiation, it did not result in a reduction in mortality after one year.

Dr. Robert N. Peck, the lead author of the study and an associate professor at Weill Cornell Medicine, acknowledged the challenge of enhancing survival rates and reducing AIDS-related deaths. The findings underscored the importance of further interventions beyond clinic access and antiretroviral therapy initiation to achieve these goals.

The research, highlighted in an editorial in JAMA, emphasized the significance of the Daraja intervention in providing vital support to hospitalized individuals with HIV. Dr. Peck collaborated with colleagues from Weill Bugando School of Medicine, the Mwanza Interventions Trial Unit, and Columbia University to develop the Daraja protocol. This initiative addressed barriers to care in Tanzania, such as stigma, lack of social support, and reliance on traditional medicines.

The Daraja intervention, meaning “bridge” in Kiswahili, aimed to bridge the gap between hospitalization, HIV clinic engagement, and improved health outcomes for patients. The study enrolled 500 individuals with HIV from 20 sites, half of whom received five sessions with a social worker post-discharge. These interactions included home visits and clinic meetings to facilitate navigation of the HIV care system and integration of antiretroviral therapy into their daily routine.

The initial outcomes were promising, with a higher percentage of participants in the intervention arm attending HIV clinics compared to the control group. The long-term effects indicated sustained clinic visits and viral load suppression in individuals who received the Daraja intervention. The program was also deemed cost-effective, with a total cost of approximately $22 per person.

While the Daraja intervention showcased positive results, the researchers noted challenges faced by participants in advanced stages of HIV and emphasized the importance of prevention, early diagnosis, and treatment. Dr. Peck highlighted the need for improved clinical care within hospitals to enhance patient outcomes and reduce mortality rates. Moving forward, the researchers propose combining enhanced clinical care with case management interventions, similar to Daraja, in future clinical trials.

Dr. Peck continues to monitor the study’s participants for an additional year to evaluate the long-term impact of the Daraja intervention on health outcomes. Despite the initial findings not showing a reduction in mortality within the first year, there is optimism that the intervention may lead to improved health outcomes in the long term.

1. Source: Coherent Market Insights, Public sources, Desk research
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