Social Worker Support to Increase Linkage to Care in Tanzania: the DARAJA Intervention

An intervention to lower post-hospital mortality for HIV-infected Tanzanians has recently begun in Mwanza, Tanzania, led by PI Dr. Robert Peck, Associate Professor of Medicine at the Center for Global Health. The intervention, called DARAJA (meaning “bridge” in Swahili), is being assessed in an NIH-funded randomized control trial run by the Center for Global Health in partnership with the Mwanza Intervention Trials Unit (MITU).

HIV care is both accessible and effective in Mwanza, yet there is still a 50% or higher mortality rate for HIV-infected patients discharged from hospitals in the region. This unfortunately high mortality rate is in large part due to the numerous barriers in linking to long-term HIV care after hospitalization. DARAJA is designed to address some of these barriers including HIV-related stigma and traditional health beliefs. The DARAJA intervention provides 5 social-worker sessions over the course of 90 days employing a goal-based, case-management approach to address individual patients’ obstacles, assess strengths and resources, and develop and implement tailored plans to link patients to sustained outpatient care to manage their HIV disease.   

DARAJA will enroll 500 participants and follow them for 1-year to assess the impact on post-hospital mortality. If DARAJA shows an effect on mortality, it could be scaled up in a multi-site implementation study to assess efficacy and if successful, integrated into the Tanzanian health system as a whole.