Implementation of a specialized inpatient HIV care model and in-hospital mortality in South Brazil: a before-after study

Abstract

Summary Background Advanced HIV disease (AHD) remains a major cause of hospitalization and mortality among people living with HIV (PLHIV). We evaluated the association between implementation of a structured specialist-led inpatient HIV care model and clinical outcomes among hospitalized PLHIV in southern Brazil. Methods We conducted an observational before–after study at a tertiary public hospital in Porto Alegre, Brazil, comparing a pre-intervention period (January 2023–April 2024) with a post-intervention period (May 2024–August 2025). The intervention included a dedicated infectious diseases team, standardized protocols for AHD and opportunistic infections, and rapid antiretroviral therapy (ART) initiation during hospitalization. Adults admitted with AHD were included. Adjusted risk ratios (aRR) for mortality, ICU admission, and a composite adverse outcome were estimated using modified Poisson regression. Findings A total of 963 hospitalizations among 899 unique patients were included (406 pre-intervention; 557 post-intervention). Baseline characteristics were similar between periods. In-hospital mortality declined from 24% to 17% (p = 0.014). In adjusted analyses, the post-intervention period was associated with lower risks of in-hospital mortality (aRR 0.74, 95% CI 0.57–0.96), ICU admission (0.70, 0.57–0.86), and composite adverse outcomes (0.78, 0.67–0.92). Opportunistic infection screening increased, lumbar puncture was performed more frequently, and ART was initiated earlier. Interpretation Implementation of a structured inpatient HIV care model was associated with improved clinical outcomes among PLHIV with AHD. Structured multidisciplinary inpatient HIV care may represent a promising approach to strengthen delivery of WHO-recommended AHD care in hospital settings and warrants further evaluation in controlled studies. Funding Pan American Health Organization (PAHO), US Centers for Disease Control and Prevention (CDC), and Unitaid.