# Re-engagement at Discharge (Re-Charge): Improving post-hospital outcomes for HIV-infected adults in Zambia

> **NIH NIH R34** · UNIVERSITY OF MARYLAND BALTIMORE · 2022 · $159,798

## Abstract

PROJECT SUMMARY
 In sub-Saharan African countries, HIV-infected patients suffer high rates of loss-to-follow-up and mortality
following hospital admission. Among HIV-infected patients at University Teaching Hospital (UTH) in Lusaka,
Zambia, we found 21% mortality three months after hospital discharge. Novel approaches are needed to re-
engage hospitalized patients in ART via the `side door' of the HIV care continuum. The Re-engagement at
Discharge (Re-Charge) study aims to understand and characterize the challenges of re-engagement in HIV
care following hospital discharge; to adapt an established intervention called Community HIV Epidemic Control
(CHEC) to support patients after discharge; and to test the discharge `d-CHEC' intervention to gain preliminary
data and experience for a future trial. CHEC is an evidence-based and PEPFAR-supported intervention that
utilizes community health workers (CHWs) to improve the HIV care continuum by addressing patient- and
system-level barriers, which we will adapt using the PRISM framework to improve post-hospitalization outcomes.
 This clinical trial planning grant includes 3 Aims: in Aim 1, we will use qualitative methods to better
understand barriers to HIV care that arise after hospital discharge in Zambia. We will conduct in-depth
interviews and focus group discussions with patients, their caregivers, CHWs, clinicians, and other Zambian
health system stakeholders to understand the patient- and system-level obstacles to health care re-engagement
following hospital discharge and identify modifiable barriers to care that may be addressed by adaptations to
CHEC. In Aim 2, we will translate the findings from Aim 1 to adapt the CHEC model to improve patient
retention in care and viral suppression in the post-discharge period. In addition to program components
identified in Aim 1, we anticipate the adapted intervention may require: (a) early engagement with the CHEC
team before discharge; (b) an electronic discharge summary to facilitate flow of patient information from hospital
to the outpatient clinic; and (c) an early post-discharge home visit from a CHW. In Aim 3, the adapted d-CHEC
will be pilot-tested and evaluated in a pre/post trial. We will enroll a representative group of HIV-infected
adult inpatients at UTH before and after d-CHEC implementation, who will then be followed 6 months after
discharge. Outcomes to be assessed include retention in care at 6 months, viral suppression, and mortality.
Using mixed methods, we will evaluate the feasibility and acceptability of the adapted d-CHEC intervention from
multiple perspectives including patients, caregivers and health care workers.
 The results will inform a fully-powered cluster-randomized R01 trial to evaluate effectiveness and costs of
the d-CHEC model. The project is significant as hospitalization is common among HIV-infected individuals, and
innovative as effective discharge interventions are lacking in sub-Saharan Africa. We are well prepared to
i...

## Key facts

- **NIH application ID:** 10337337
- **Project number:** 5R34MH122265-02
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Cassidy W. Claassen
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $159,798
- **Award type:** 5
- **Project period:** 2021-02-01 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10337337

## Citation

> US National Institutes of Health, RePORTER application 10337337, Re-engagement at Discharge (Re-Charge): Improving post-hospital outcomes for HIV-infected adults in Zambia (5R34MH122265-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10337337. Licensed CC0.

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