RT Journal Article
SR Electronic
T1 Enhancing Antiretroviral Therapy Initiation for Hospitalized and Recently Discharged People Living With HIV in Johannesburg, South Africa
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2400017
DO 10.9745/GHSP-D-24-00017
VO 13
IS 1
A1 Davies, Natasha
A1 Bisnauth, Melanie
A1 Rees, Kate
YR 2025
UL http://www.ghspjournal.org/content/13/1/e2400017.abstract
AB Key FindingsUsing a quality improvement approach, we implemented and refined a structured intervention that mirrored primary health care (PHC) staff roles to improve HIV case finding, ART initiation, and post-discharge support for hospitalized patients with HIV.Over 11 months, we achieved an ART initiation rate of 74% (in-hospital and within 28 days of discharge), well above the global average of 42%. The model effectively closed the gender gap, with males and females achieving comparable initiation rates.Regular review meetings ensured teams received implementation support and enabled critical analysis of monitoring data and performance.Key ImplicationsHospitals are a key entry point for individuals requiring ART, with many individuals with advanced HIV newly diagnosed or re-engaging in care during hospital admission. Policymakers and managers should review hospital-based HIV service structures and protocols, ensuring clearly defined roles and responsibilities, strengthening communication pathways, and developing mechanisms to safeguard linkage between hospital and PHC facilities after discharge.Policymakers, managers, and national stakeholders should prioritize addressing acknowledged weaknesses in hospital-based HIV services and consider implementing a quality improvement model to ensure effective HIV services are established in high-burden countries.Background:Despite increased antiretroviral therapy (ART) access in South Africa, HIV testing and ART initiation are suboptimal in hospital settings. Key gaps include in-hospital case finding, ART initiation support, and primary health care (PHC) facility linkage after discharge.Intervention Development and Description:We identified weaknesses in hospital processes by comparing them with PHC HIV services and developed a quality improvement model for implementation in 5 Johannesburg hospitals. We introduced dedicated teams of HIV testing counselors for structured case finding and ART-trained nurses and linkage officers to provide in-hospital or post-discharge ART initiation and support to strengthen PHC facility linkage. Monitoring data (May 2020–March 2021) was used to measure initiation rates.Lessons Learned:Over 11 months, despite COVID-19 pandemic-related disruptions, our model achieved 74% (5,201/7,025) ART linkage within 28 days post-discharge and 87% (6,087/7,025) overall, including all initiations (i.e., all newly diagnosed, known not on ART and reinitiating individuals). The 2 highest-performing hospitals achieved 97% (2,096/2,170) linkage overall, demonstrating the potential of implementing this quality improvement model with fidelity. Over half (58%, 4,092/7,025) of patients initiated ART within 7 days, with 39% (2,748) initiating on the same day. Women and men achieved similar initiation rates (3,010/4,015, 75%; 2,186/3,003, 73%, respectively). Combining rapid (<7 days) in-hospital ART initiation with 28-day post-discharge follow-up supported high ART initiation rates. Using the model mitigated initiation gaps for men and older people, engaging stakeholders supported implementation, and using a team-based approach founded on clear roles and responsibilities improved service delivery.Conclusion:This model achieved above-average ART linkage rates in a large hospitalized population. We recommend considering introducing this model or adaptations of it to hospitals across South Africa and similar settings where hospital-to-PHC ART service gaps are identified to optimize case finding, ART initiation, and post-discharge linkage support.