Reducing Post-Hospital Mortality in HIV-infected Adults in Tanzania (Daraja Trial)
Results from our studies in Tanzania and other African countries show that 2 out of 10 adult admissions to medical wards in Africa are HIV-related. Furthermore, only 6 out of 10 HIV-infected adults discharged from hospitals remain alive for one year. This relatively low survival is due to poor linkage of patients to outpatient clinics for lifesaving HIV care after hospital discharge. There have been no trials in Africa studying the optimal strategy to transition HIV-infected adults from the hospital to HIV clinic.
We conducted a preliminary study in Mwanza, Tanzania to understand why HIV-infected adults discharged from hospitals failed to link to HIV primary care and identified a number of factors associated with poor 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. To address these factors, we developed an intervention which involves a social worker meeting each patient to facilitate linkage to outpatient HIV care. We named our intervention Daraja (Swahili for BRIDGE) since the social worker acts as a bridge helping the patient transition from the hospital to the clinic.
To evaluate the efficacy of the DARAJA social worker intervention versus standard of care on increasing the one-year survival rate in 500 HIV-infected adults consecutively discharged from the study hospitals.
This is a randomised controlled trial involving 500 HIV-infected adults who have been hospitalized in public or non-profit hospitals in Mwanza region. Participants will be enrolled and randomized 2-3 days prior to hospital discharge, to either receive the DARAJA intervention (N=250) or the standard of care (N=250). HIV-infected adults randomised to the DARAJA intervention will have 5 sessions with a trained social worker over a 3-month period, the first meeting being in the hospital on the morning of discharge, the second at the patient’s home, and the three subsequent visits either in the patient’s home or outpatient HIV clinic. The control group will not receive the DARAJA intervention. All other aspects of care in the two groups will be the same and follow current standard practice.
MITU, Tanzania/London School of Hygiene & Tropical Medicine, UK: Heiner Grosskurth, Philip Ayieko, MITU, Tanzania: Elialilia Okello, Ramadhan Hashim, Godfrey Kisigo, Severin Kabakama, Derick Deogratias; Columbia University, NY, USA: Lisa Metsch; Mwanza Regional Medical Office, Tanzania: Thomas Rutachunzibwa; Weill Cornell Medical College, NY, USA: Myung Hee Lee, Daniel Fitzgerald, Sean Murphy