• Open Access

Cost of using a patient tracer to reduce loss to follow-up and ascertain patient status in a large antiretroviral therapy program in Johannesburg, South Africa

Authors

  • Sydney Rosen,

    1.  Center for Global Health and Development, Boston University, Boston MA, USA
    2.  Health Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa
    3.  Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
    Search for more papers by this author
  • Mpefe Ketlhapile

    1.  Health Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa
    Search for more papers by this author

Corresponding Author Sydney Rosen, Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown 3rd Floor, Boston, MA 02118, USA. Tel.: +1 617 414 1273; E-mail: sbrosen@bu.edu

Summary

Objective  To evaluate a pilot intervention to engage a patient tracer to follow up lost patients at a large public clinic in South Africa.

Methods  A social worker spent 4 months contacting by telephone a random sample of patients who had initiated antiretroviral therapy (ART) at least 6 months earlier and were ≥1 month late for a scheduled visit. The tracer was authorized to assist patients to return to care if needed. Cost was calculated from the perspective of the clinic.

Results  The tracer was able to determine the final status of 260 of a sample of 493 lost patients. Of the 260, 55 (21%) had died, 56 (21%) were still on ART at the same site, 79 (30%) reported transferring to another site and 70 (27%) had discontinued treatment. Among those discontinuing, commonly cited reasons were relocation (n = 18, 26%), traditional medicine or religious beliefs (n = 11, 16%), fear of disclosure or other family barriers (n = 9, 13%), and employment obstacles (n = 7, 10%). Twenty patients returned to care at the original site as a result of the intervention, at an average cost of $432 per patient returned.

Conclusions  A patient tracer was an effective way to determine the final status of lost patients and succeeded in returning some to care, but the cost per patient returned was high. Better information systems allowing sites to track deaths and transfers would greatly improve the efficiency of loss to follow-up interventions.

Ancillary