Abstract
BackgroundLoss to follow-up is a major challenge of antiretroviral treatment (ART) programs in sub-Saharan Africa. Our objective was to a) determine true outcomes of patients lost to follow-up (LTFU) and b) identify risk factors associated with successful tracing and deaths of patients LTFU from ART in a large public sector clinic in Lilongwe, Malawi.MethodsPatients who were more than 2 weeks late according to their last ART supply and who provided a phone number or address in Lilongwe were eligible for tracing. Their outcomes were updated and risk factors for successful tracing and death were examined.ResultsOf 1800 patients LTFU with consent for tracing, 724 (40%) were eligible and tracing was successful in 534 (74%): 285 (53%) were found to be alive and on ART; 32 (6%) had stopped ART; and 217 (41%) had died. Having a phone contact doubled tracing success (adjusted odds ratio, aOR = 2.1, 95% CI 1.4-3.0) and odds of identifying deaths [aOR = 1.8 (1.2-2.7)] in patients successfully traced. Mortality was higher when ART was fee-based at initiation (aOR = 2.3, 95% CI 1.1-4.7) and declined with follow-up time on ART. Limiting the analysis to patients living in Lilongwe did not change the main findings.ConclusionAscertainment of contact information is a prerequisite for tracing, which can reveal outcomes of a large proportion of patients LTFU. Having a phone contact number is critical for successful tracing, but further research should focus on understanding whether phone tracing is associated with any differential reporting of mortality or LTFU.
Highlights
Loss to follow-up is a major challenge of antiretroviral treatment (ART) programs in sub-Saharan Africa
The large proportion of patients lost to follow-up (LTFU) is one of the major challenges to the ongoing success of antiretroviral treatment (ART) programs in sub-Saharan Africa [1,2,3]
Recruitment of study participants, baseline characteristics and outcomes of patients lost to follow-up Until 31st May 2005, 3846 patients had ever started ART at the Lighthouse and 1840 (48%) were LTFU, of whom 1800 (98%) had given consent to tracing (Figure 1)
Summary
Loss to follow-up is a major challenge of antiretroviral treatment (ART) programs in sub-Saharan Africa. Our objective was to a) determine true outcomes of patients lost to follow-up (LTFU) and b) identify risk factors associated with successful tracing and deaths of patients LTFU from ART in a large public sector clinic in Lilongwe, Malawi. The large proportion of patients lost to follow-up (LTFU) is one of the major challenges to the ongoing success of antiretroviral treatment (ART) programs in sub-Saharan Africa [1,2,3]. A systematic review found that about 40% of patients in sub-Saharan Africa were lost at two years, with large variation in retention rates between programs [2]. ART clinics face serious operational challenges to trace patients LTFU. True outcomes of patients LTFU are difficult to assess: definitions and intervals that trigger tracing vary, active tracing of patients is labor- and time-intensive, and in 34% of traced patients the vital status still remains unknown [4]
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