Davies Natasha, Bisnauth Melanie, Rees Kate
Anova Health Institute, Johannesburg, South Africa.
Department of Community Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Glob Health Sci Pract. 2025 Aug 14;13(1). doi: 10.9745/GHSP-D-24-00017.
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.
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.
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.
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.
尽管南非接受抗逆转录病毒治疗（ART）的机会有所增加，但医院环境中的艾滋病毒检测和ART启动情况仍不理想。主要差距包括院内病例发现、ART启动支持以及出院后与初级卫生保健（PHC）机构的联系。
我们通过将医院流程与PHC艾滋病毒服务进行比较，确定了医院流程中的薄弱环节，并开发了一种质量改进模型，在约翰内斯堡的5家医院实施。我们引入了专门的艾滋病毒检测咨询团队进行结构化病例发现，并安排了接受过ART培训的护士和联系官员，以提供院内或出院后的ART启动和支持，加强与PHC机构的联系。利用监测数据（2020年5月至2021年3月）来衡量启动率。
在11个月的时间里，尽管受到与COVID-19大流行相关的干扰，但我们的模型在出院后28天内实现了74%（5201/7025）的ART联系率，总体联系率达到87%（6087/7025），包括所有启动情况（即所有新诊断、已知未接受ART治疗以及重新开始治疗的个体）。表现最佳的两家医院总体联系率达到97%（2096/2170），这表明忠实地实施这种质量改进模型具有潜力。超过一半（58%，4092/7025）的患者在7天内开始接受ART治疗，其中39%（2748例）在同一天开始治疗。女性和男性的启动率相似（分别为3010/4015，75%；2186/3003，73%）。将快速（<7天）的院内ART启动与出院后28天的随访相结合，支持了较高的ART启动率运用该模型缩小了男性和老年人的启动差距，让利益相关者参与有助于实施，采用基于明确角色和职责的团队方法改善了服务提供。
该模型在大量住院人群中实现了高于平均水平的ART联系率。我们建议考虑在南非各地的医院以及发现存在医院到PHC的ART服务差距的类似环境中引入该模型或对其进行调整，以优化病例发现、ART启动以及出院后联系支持。
