Abstract:
Background: Academic Model Providing Access To Healthcare
(AMPATH) program provides comprehensive HIV care and treat ment services. Approximately, 30% of patients have become lost to
follow-up (LTFU). We sought to actively trace and identify
outcomes for a sample of these patients.
Methods: LTFU was defined as missing a scheduled visit by $3
months. A randomly selected sample of 17% of patients identified as
LTFU between January 2009 and June 2011 was generated, with
sample stratification on age, antiretroviral therapy (ART) status at
last visit, and facility. Chart reviews were conducted followed by
active tracing. Tracing was completed by trained HIV-positive
outreach workers July 2011 to February 2012. Outcomes were
compared between adults and children and by ART status.
Results: Of 14,811 LTFU patients, 2540 were randomly selected
for tracing (2179 adults, 1071 on ART). The chart reviews indicated
that 326 (12.8%) patients were not actually LTFU. Outcomes for
71% of sampled patients were determined including 85% of those
physically traced. Of those with known outcomes, 21% had died,
whereas 29% had disengaged from care for various reasons. The
remaining patients had moved away (n = 458, 25%) or were still
receiving HIV care (n = 443 total, 25%).Conclusions: Our findings demonstrate the feasibility of a large scale sampling-based approach. A significant proportion of patients
were found not to be LTFU, and further, high numbers of patients who
were LTFU could not be located. Over a quarter of patients
disengaged from care for various reasons including access challenges
and familial influences.
