Strategies for improving linkage to HIV care after hospital discharge among adults living with HIV in low- and middle-income countries: a systematic review.
Despite the availability of antiretroviral therapy (ART), nearly a quarter of people living with HIV (PLHIV) die within six months after hospital discharge due to complications from AIDS-related illnesses. Timely linkage to ART clinics after hospital discharge is crucial in reducing this mortality. We performed a systematic review to collate the available evidence on the strategies used to improve linkage to ART clinics after hospital discharge to inform future interventions.
We systematically searched PUBMED, web of science, google scholar, embase and cochrane central for randomized controlled trials and quasi-experimental intervention trials conducted from January 2006 to December 2024, involving PLHIV aged 18 years and above in Low and Middle Income Countries (LMICs). Studies were included if they: (i) collected data in or after 2006, (ii) used randomized controlled trials (RCTs) or quasi-experimental prospective designs with a control group, (iii) reported at least one of several potential outcomes related to linkage to HIV ART clinics, and (iv) reported at least one strategy used to link PLHIV to HIV care after hospital discharge. Risk of bias was assessed using the Cochrane "risk of bias" tool for RCTs and the ROBINS-I tool for non-randomized studies of interventions. We used a narrative synthesis of articles to describe the different strategies used to enhance linkage to HIV ART clinics after hospital discharge.
From the initial pool of 3003 articles, nine papers were independently reviewed and four (4) met the inclusion criteria. All the studies were conducted between 2011 and 2024 and comprised three RCTs and one quasi-experimental study. All the articles exhibited a low risk of bias. Strategies used to improve linkage to HIV care ART clinics included use of mobile phone appointment reminders, patient health education during hospitalization, multiple counseling sessions after hospital discharge, and the use of incentives such as food parcels.
Only few studies from LMICs have investigated strategies for linkage to ART clinics among PLHIV after hospital discharge. All the identified studies had more than one strategy applied. Further implementation research is recommended to explore context-specific strategies and strengthen the evidence base for improving linkage to ART clinics following hospital discharge.
The protocol for this review was prespecified and published in PROSPERO (registration number (CRD42018110036).
We systematically searched PUBMED, web of science, google scholar, embase and cochrane central for randomized controlled trials and quasi-experimental intervention trials conducted from January 2006 to December 2024, involving PLHIV aged 18 years and above in Low and Middle Income Countries (LMICs). Studies were included if they: (i) collected data in or after 2006, (ii) used randomized controlled trials (RCTs) or quasi-experimental prospective designs with a control group, (iii) reported at least one of several potential outcomes related to linkage to HIV ART clinics, and (iv) reported at least one strategy used to link PLHIV to HIV care after hospital discharge. Risk of bias was assessed using the Cochrane "risk of bias" tool for RCTs and the ROBINS-I tool for non-randomized studies of interventions. We used a narrative synthesis of articles to describe the different strategies used to enhance linkage to HIV ART clinics after hospital discharge.
From the initial pool of 3003 articles, nine papers were independently reviewed and four (4) met the inclusion criteria. All the studies were conducted between 2011 and 2024 and comprised three RCTs and one quasi-experimental study. All the articles exhibited a low risk of bias. Strategies used to improve linkage to HIV care ART clinics included use of mobile phone appointment reminders, patient health education during hospitalization, multiple counseling sessions after hospital discharge, and the use of incentives such as food parcels.
Only few studies from LMICs have investigated strategies for linkage to ART clinics among PLHIV after hospital discharge. All the identified studies had more than one strategy applied. Further implementation research is recommended to explore context-specific strategies and strengthen the evidence base for improving linkage to ART clinics following hospital discharge.
The protocol for this review was prespecified and published in PROSPERO (registration number (CRD42018110036).
Authors
Katuramu Katuramu, Matovu Matovu, Kirabira Kirabira, Nangendo Nangendo, Byakika-Kibwika Byakika-Kibwika, Kamya Kamya
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