Tracing patients on antiretroviral treatment lost-to-follow-up in an urban slum in India
Article first published online: 25 JAN 2012
© 2012 Blackwell Publishing Ltd
Journal of Advanced Nursing
Volume 68, Issue 11, pages 2399–2409, November 2012
How to Cite
Errol, L., Isaakidis, P., Zachariah, R., Ali, M., Pilankar, G., Maurya, S., Geraets, C., Ladomirska, J., Patel, S. and Reid, T. (2012), Tracing patients on antiretroviral treatment lost-to-follow-up in an urban slum in India. Journal of Advanced Nursing, 68: 2399–2409. doi: 10.1111/j.1365-2648.2011.05934.x
- Issue published online: 24 SEP 2012
- Article first published online: 25 JAN 2012
- Accepted for publication 17 December 2011
- HIV disclosure;
- patient tracing;
- resource-limited settings
errol l., isaakidis p., zachariah r., ali m., pilankar g., maurya s., geraets c., ladomirska j., patel s. & reid t. (2012) Tracing patients on antiretroviral treatment lost-to-follow-up in an urban slum in India. Journal of Advanced Nursing68(11), 2399–2409.
Aim. This article describes a cooperative initiative between an HIV-clinic and non-government organization network providing lost-to-follow-up tracing and delayed appointment follow-up of patients on antiretroviral treatment.
Background. Loss-to-follow-up among patients on antiretroviral treatment is a major challenge in resource-constrained settings. A model of cooperation between a Médecins Sans Frontières HIV-clinic and a non-governmental-organization network was piloted in a Mumbai slum. A steady decline in delayed appointments and loss-to-follow-up was observed over 4 years.
Design. Mixed method study.
Methods. A study conducted in January 2011 explored potential reasons for declining loss-to-follow-up-rates. A retrospective, quantitative analysis of patient data was undertaken complemented by 22 semi-structured interviews, four focus-group discussions to explore patients’ and providers’ perceptions of tracing activities.
Results/findings. The clinic loss-to-follow-up-rate has steadily declined from mid-2008–2011. Thirty-eight (4·6%) of 819 patients registered during the period were lost-to-follow-up with most lost during the first year. Rates of loss-to-follow-up between 0·3–2·4% were observed over the last 2 years. Phoning the day before an appointment was perceived as the most useful intervention to avoid missing appointments. The analysis revealed a widespread fear of forced disclosure by patients during home visits.
Conclusions. The low loss-to-follow-up-rate cannot be attributed to the network tracing activities alone. Phoning before appointments may result in fewer delayed appointments and prevent loss-to-follow-up. Home visits should be a last resort method of patient tracing because of the risk of HIV-status disclosure and the opportunity of discrimination from family and neighbours.