# HomeLink2: Reducing posthospitalization mortality among people living with HIV through structured home care and nutritional supplementation

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $650,112

## Abstract

PROJECT SUMMARY
HIV remains the leading cause of death among adults in South Africa despite the availability of antiretroviral
therapy (ART) due to failure to initiate ART and failure to remain on ART. Among people living with HIV
(PLWH) who are hospitalized, 17-26% die within 6 months of hospital discharge potentially contributing to
more than half of all HIV-associated mortality in South Africa. There are heterogenous reasons for mortality
that include missed diagnoses, psychosocial barriers to completing treatment plans, and structural barriers that
include food insecurity. To respond to the complexity of underlying causes of mortality we developed and
piloted a disease neutral intervention to reduce posthospitalization mortality: HomeLink. This intervention
consisted of structured posthospitalization home care visits with psychosocial counselling and nutritional
supplementation and reduced posthospitalization mortality by 60%. These results raise important questions
regarding reproducibility and scale-up of this intervention. In order to inform policy, the most feasible and cost-
effective elements need to be identified. Here we are proposing a fully powered study of a refined HomeLink2
intervention to compare usual care to structured home visits or home visits plus nutritional supplementation. In
addition, we will identify underlying mechanisms of the intervention effectiveness including the impact on
timeliness of acute care, medical diagnoses, adherence to ART (through viral load testing), and psychosocial
metrics. We will further assess implementation outcomes to guide future refinement of intervention delivery.
Finally, we will use findings from the randomized trial to complete costing and cost-effectiveness analyses to
inform policy makers regarding cost of HomeLink2 and cost-effectiveness of home visits alone or home visits
plus nutritional support to inform potential scale-up and long-term sustainability. This project has the potential
to generate considerable new knowledge on interventions that could dramatically reduce HIV-associated
mortality in South Africa and other low- and middle-income settings. This proposed study is very likely to
generate actionable knowledge to improve outcomes for PLWH and contribute to overall goals of HIV epidemic
control.

## Key facts

- **NIH application ID:** 11009327
- **Project number:** 1R01MH138270-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** CHRISTOPHER J HOFFMANN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $650,112
- **Award type:** 1
- **Project period:** 2024-09-04 → 2029-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11009327

## Citation

> US National Institutes of Health, RePORTER application 11009327, HomeLink2: Reducing posthospitalization mortality among people living with HIV through structured home care and nutritional supplementation (1R01MH138270-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/11009327. Licensed CC0.

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