title: What happens to patients on antiretroviral therapy who transfer out to another facility?
abstract: BACKGROUND
  Long term retention of patients on antiretroviral therapy (ART) in Africa's rapidly expanding programmes is said to be 60% at 2 years. Many reports from African ART programmes make little mention of patients who are transferred out to another facility, yet Malawi's national figures show a transfer out of 9%. There is no published information about what happens to patients who transfer-out, but this is important because if they transfer-in and stay alive in these other facilities then national retention figures will be better than previously reported.
  
  
  RESULTS
  Of all patients started on ART over a three year period in Mzuzu Central Hospital, North Region, Malawi, those who transferred out were identified from the ART register and master cards. Clinic staff attempted to trace these patients to determine whether they had transferred in to a new ART facility and their outcome status. There were 805 patients (19% of the total cohort) who transferred out, of whom 737 (92%) were traced as having transferred in to a new ART facility, with a median time of 1.3 months between transferring-out and transferring-in. Survival probability was superior and deaths were lower in the transfer-out patients compared with those who did not transfer.
  
  
  CONCLUSIONS
  In Mzuzu Central Hospital, patients who transfer-out constitute a large proportion of patients not retained on ART at their original clinic of registration. Good documentation of transfer-outs and transfer-ins are needed to keep track of national outcomes. Furthermore, the current practice of regarding transfer-outs as being double counted in national cohorts and subtracting this number from the total national registrations to get the number of new patients started on ART is correct.
authors.affiliation: Taiwan Medical Mission in Malawi, Mzuzu Central Hospital, Mzuzu, Malawi.
authors.forename: Joseph Kwong-Leung
authors.initials: JK
authors.lastname: Yu
authors.forename: Teck-Siang
authors.initials: TS
authors.lastname: Tok
authors.forename: Jih-Jin
authors.initials: JJ
authors.lastname: Tsai
authors.forename: Wu-Shou
authors.initials: WS
authors.lastname: Chang
authors.forename: Rose K
authors.initials: RK
authors.lastname: Dzimadzi
authors.forename: Ping-Hsiang
authors.initials: PH
authors.lastname: Yen
authors.forename: Simon D
authors.initials: SD
authors.lastname: Makombe
authors.forename: Amon
authors.initials: A
authors.lastname: Nkhata
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schouten
authors.forename: Kelita
authors.initials: K
authors.lastname: Kamoto
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D006761:Hospitals; D006801:Humans; D008295:Malawi; D008297:Male; D010360:Patient Transfer; D016019:Survival Analysis; D016896:Treatment Outcome