True outcomes for patients on antiretroviral therapy who are "lost to follow-up" in Malawi.
OBJECTIVE
In many resource-poor countries that are scaling up antiretroviral therapy (ART), 5-25% of patients are reported as "lost to follow-up". This figure is 9% in Malawi. There is no published information about the true outcome status of these patients.


METHODS
In four facilities in northern Malawi, ART registers and master cards were used to identify patients who had not attended the facility for 3 months or more and were thus registered as "lost to follow-up". Clinic staff attempted to trace these patients and ascertain their true outcome status.


METHODS
Of 253 patients identified as "lost to follow-up", 127 (50%) were dead, 58% of these having died within 3 months of their last clinic visit. Of the 58 patients (23%) found to be alive, 21 were still receiving ART and 37 had stopped treatment (high transport costs being the main reason for 13 patients). Sixty-eight patients (27%) could not be traced, most commonly because of an incorrect address in the register. Fewer patients were alive and more patients could not be traced from the central hospital compared with the peripheral hospitals.


RESULTS
Better documentation of patients addresses and prompt follow-up of patients who are late for their appointments are required.


CONCLUSIONS
ART clinics in resource-poor countries should ensure that patients addresses are correct and comprehensive. Clinics should also undertake contact tracing as soon as possible in the event of non-attendance, consider facilitating access to ART clinics and take loss to follow-up into consideration when assessing death rates.
Yu
Joseph Kwong-Leung
JK
Taiwan Medical Mission to Malawi, Mzuzu Central Hospital, Mzuzu, Malawi.
Chen
Solomon Chih-Cheng
SC
Wang
Kuo-Yang
KY
Chang
Chao-Sung
CS
Makombe
Simon D
SD
Schouten
Erik J
EJ
Harries
Anthony D
AD
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010352:Patient Dropouts; D011204:Poverty Areas; D016896:Treatment Outcome
D019380:Anti-HIV Agents