The case-management process proactively identifies clients who are not likely to adhere to complex treatment requirements such as antiretroviral therapy (ART)—clients who are at risk of being "lost to follow-up." Lost to follow-up refers to clients who have dropped out of their treatment regimens and are unfindable. Case management is about preventing clients from dropping out of treatment by proactively managing and meeting their specific, individualized needs. Case management also involves shifting tasks from over-burdened clinical staff to a trained case manager.
The best way to prevent lost-to-follow-up clients is to proactively identify those who may not be likely to adhere to treatment requirements. In the case-management process, when ART is initiated, clients are assessed on an "acuity scale" to determine whether they are at risk to become lost to follow-up or to not comply with the treatment requirements that help people living with HIV/AIDS (PLWHIV) maintain a better quality of life. The acuity scale provides the case manager with an indication of the level, intensity, and frequency of support services that may be required by those clients who are at risk to help ensure their treatment adherence. Once identified, clients are provided with timely and sustained support.
Health care providers who administer ART refer patients to case managers based on need and risk status for compliance to adherence, such as food insecurity, lack of transportation, substance dependency, non-disclosure of HIV status, shelter instability, pregnancy, or disease severity/complexity. The case manager develops a comprehensive care plan after performing a holistic assessment of the client’s needs. The case manager is a vital member of the ART client treatment team.
Case management is not a new phenomenon. Many countries have implemented case management as a mode of services delivery for chronic illnesses, where customized and sustained care is required.
Ethiopia Spotlight: A Client's Case—A True Story
One client had lost all hope when he was presented with an HIV-positive test result. His wife also tested positive. He could not find work. He started avoiding others and was not adhering to his ART regimen. Eventually, he became blind and lost hearing in one ear. He says that, "I lost all of my strength, and was counting the days until I died."
A year and a half after receiving his diagnosis, the client was introduced to a case manager at Mekele Hospital. "My hope was rekindled," he says. The case manager informed him about the importance of adhering to his antiretroviral medications (ARVs), and he now takes them regularly.
Currently, rather than hiding from people that might recognize him, this client is publicly educating others about HIV and AIDS. "I am a full member of the Adherence Support Group organized by my case manager. I regularly attend the meetings and have assumed the task of counseling fellow clients who are about to quit taking the medications. My wife also works like me."
He adds, "Even though I am visually impaired, I found out that I can work and learn. My case manager referred and linked me to different care and support organizations. I received a rope weaving training for four months at the Association for Disabled People. I received my certificate and some money as an initial investment. Now I am making preparations to start working at home to sell the items. I had quit my education after passing the 8th grade. But now my case manager is helping me to [continue] my education at a school for the blind."