Ensuring effective transitions in care for hospitalized people living with HIV

Recent changes in the global health financing resulted in a steep reduction in donor support for HIV programmes worldwide, threatening years of progress in reducing infections and mortality. These developments require existing HIV programmes to rethink their priorities. Advanced HIV disease (AHD) is a condition present in approximately 30% of people living with HIV (PLHIV) presenting to HIV care programmes worldwide. These individuals are defined by their low immune status, having a CD4 cell count ≤200 cells/mm3 or World Health Organization (WHO) Clinical Stage 3 or 4 AIDS-defining illness—and are at significantly greater risk of hospitalization and poor outcomes following discharge from hospital. A recent systematic review found that in low-and middle-income settings, 19% of those discharged from hospital were subsequently readmitted, and 14% died. Post-discharge outcomes are an important and often poorly acknowledged gap in the HIV care cascade where PLHIV fail to successfully return to regular care services. In this mini-review, we provide an overview on post-discharge outcomes for PLHIV and suggest a way forward for expanding current service delivery approaches to improve outcomes. The focus is on low-income settings, but reflects broader trends on post-discharge outcomes for PLHIV.