Monitoring Patients Lost to Follow-Up (LTFU) in Ethiopia
Background
There are an estimated 1.3 million people living with HIV and AIDS (PLHIVs) in Ethiopia. In 2005, the Ethiopian Ministry of Health launched a free antiretroviral therapy (ART) program. As of April 2007, roughly 140,000 PLHIVs were enrolled in chronic HIV and AIDS care. Of these, 83,099 started on ART; however, only 76% (63,122 people) remained in care, leaving approximately 20,000 patients as lost to follow-up (LTFU). Within the Amhara region, the number of PLHIVs is estimated at 444,560, of which 30,629 were enrolled in chronic care. Approximately 19,779 of patients had started ART, but only 79.3% (15,703) continued the therapy. This means that 20.7% of patients enrolled in chronic HIV and AIDS care did not show up to the clinic on their scheduled appointment dates, and thus could be considered LTFU. The status of patients LTFU had not been established at most HIV and AIDS chronic care facilities—patients had simply been marked as "lost" in the ART register. In mid-September 2006, I-TECH led a pilot outreach program at Gondar University Hospital (GUH), which involved training and employment of ART patients to investigate patient LTFU cases.
The aim of the project was to:
- Identify reasons why patients at the ART clinic are lost to follow-up.
- Improve the adherence of ART patients by making contact with patients who do not show up to the pharmacy or clinic as instructed.
- Pilot test a mechanism for improving adherence and determining the outcomes of patients "lost to follow-up" that could be implemented at other ART clinics in Ethiopia and at other I-TECH hospital-based ART clinics.
Methods
- Review clinics' LTFU lists with other ward registration books to create an accurate documentation of current LTFU patients.
- Conduct telephone interviews with LTFU patients that had telephone numbers on file.
- Conduct home visitations and interviews with LTFU patients who were unreachable by telephone.
