# Reducing Post-Hospital Mortality in HIV-Infected Adults in Tanzania

> **NIH NIH R01** · WEILL MEDICAL COLL OF CORNELL UNIV · 2020 · $531,060

## Abstract

ABSTRACT: Hospitalization of HIV-infected adults in Africa is often the last opportunity to initiate and maintain
life-saving HIV care. Despite the roll out of ART, HIV remains the most common cause of admission to medical
wards in Africa. Our data in Tanzania and other data from Africa indicate that 25-40% of hospitalized HIV-
infected adults will die within 1 year of hospital discharge. This high post-hospital mortality is strongly
associated with failure to link to primary HIV care after hospital discharge.
In collaboration with our Tanzanian partners, we have conducted formative research and have developed a
social worker intervention to address this critical gap between hospital and HIV clinic. Utilizing the Gelberg and
Andersen Behavioral Model of Health Services Utilization for Vulnerable Population, we identified 8 factors that
are associated with poor post-hospital clinic linkage including: unemployment, traditional health beliefs, low
self-efficacy, lack of transportation, lack of social support, stigma, low perceived need for HIV care, and
physical weakness. Based on these factors, we adapted an evidence-based social worker intervention
(ARTAS) which has been effective in improving linkage in the United States. A pilot of the social worker
intervention in 31 HIV-infected patients at Bugando Medical Center in Mwanza, Tanzania showed that linkage
improved from 63% to 100% and survival from 75% to 90% when compared to historical controls.
Based on these pilot data, we propose a randomized clinical trial at the public Bugando Medical Center
(BMC) and its associated HIV clinic in Mwanza, Tanzania. Our primary aim is to evaluate the efficacy of the
social worker intervention to increase the 1-year survival rate in 500 HIV infected adults consecutively
discharged from the Bugando Medical Center. We hypothesize that the one-year survival will be 90% in the
intervention group vs. 75% in the standard care group. We will have >80% power to detect this 15% absolute
difference in survival at p<0.05. Secondary aims will include: 1) to compare linkage to the HIV clinic and
subsequent steps in the HIV care continuum, 2) to validate the Gelberg and Andersen Model, 3) to determine
the acceptability of the intervention, and 4) to calculate the incremental cost and cost per life saved.
The goal of this proposal is to develop a model of care for hospitalized HIV-infected adults to improve their
linkage to outpatient care and post-hospital survival. Improving outcomes for HIV-infected adults could save
several hundred thousand lives across Africa each year. After the successful completion of this trial, we will
conduct implementation studies with our partners in the Tanzanian Ministry of Health to demonstrate scalability
and cost-effectiveness.

## Key facts

- **NIH application ID:** 9934020
- **Project number:** 5R01MH118107-03
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Robert N Peck
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $531,060
- **Award type:** 5
- **Project period:** 2018-08-09 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9934020

## Citation

> US National Institutes of Health, RePORTER application 9934020, Reducing Post-Hospital Mortality in HIV-Infected Adults in Tanzania (5R01MH118107-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9934020. Licensed CC0.

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