Social and Structural Interventions to Reduce Strikingly High Post-Hospital Mortality for People Living with HIV in Sub-Saharan Africa.

Abstract

Purpose of review: Death following hospitalization remains strikingly high for people living with HIV (PLHIV) in sub-Saharan Africa. Hospitalization represents a key opportunity for targeted interventions, yet evidence for effective approaches remains limited. We conducted a best-evidence narrative review, framed by the Andersen Model of Health Care Utilization, to examine factors contributing to post-hospital mortality and assess recent interventions.

Recent findings: PLHIV in sub-Saharan Africa have a 12-26% risk of death within 3-6 months of discharge. Social and structural barriers-including poverty, stigma, food insecurity, and low self-efficacy-are central mediating factors. We reviewed three disease-neutral interventions (HomeLink, Daraja, ReCharge) providing home-based support, counseling, and care linkage. While feasible and acceptable, mortality impact was mixed due to small sample sizes and advanced illness. The hospital-to-home transition is a critical window for intensified differentiated services to reduce mortality among PLHIV. Further research is needed to define scalable and cost-effective models to improve survival and close gaps in HIV care.