title: Early active follow-up of patients on antiretroviral therapy (ART) who are lost to follow-up: the 'Back-to-Care' project in Lilongwe, Malawi.
abstract: OBJECTIVE
  To determine the proportion of patients returning to antiretroviral treatment (ART) and factors associated with their return in a resource-limited setting.
  
  
  METHODS
  Between September 2006 and March 2009, at two ART-providing facilities in Lilongwe, Malawi, we identified patients who had missed clinic appointments by more than 3 weeks and therefore would have run out of antiretroviral drugs. We traced these individuals, documented reasons for missed appointments and, where appropriate, arranged another ART clinic appointment.
  
  
  RESULTS
  Between April 2006 and March 2009, 2653 patients on ART had missed 3098 scheduled appointments. We successfully traced 85%, of whom 30% had died. Of the 1580 patients found alive, 25% had transferred to another ART clinic, 21% had collected drugs from other sources, 11% had treatment gaps; 40% had stopped taking drugs, 1% had not started taking drugs despite collecting them and 2% refused to be interviewed. Of the 1158 LTFU patients who had not died, transferred out or declined to be interviewed, 89% promised to return to their ART clinic and 74% actually did. The probability of returning to the clinic was significantly associated with being women, aged over 39 at ART initiation and having either treatment gaps or uninterrupted therapy. The B2C project reduced the proportion of patients finally classified as LTFU by 59%.
  
  
  CONCLUSIONS
  Early active follow-up of LTFU patients resulted in marked improvement in known patient outcomes and improved retention in the treatment programme.
authors.affiliation: The International Union Against Tuberculosis and Lung Disease, Paris, France. h_tweya@lighthouse.org.mw
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.forename: Dickman
authors.initials: D
authors.lastname: Gareta
authors.forename: Fredrick
authors.initials: F
authors.lastname: Chagwera
authors.forename: Anne
authors.initials: A
authors.lastname: Ben-Smith
authors.forename: Justin
authors.initials: J
authors.lastname: Mwenyemasi
authors.forename: Fred
authors.initials: F
authors.lastname: Chiputula
authors.forename: Matthew
authors.initials: M
authors.lastname: Boxshall
authors.forename: Ralf
authors.initials: R
authors.lastname: Weigel
authors.forename: Andreas
authors.initials: A
authors.lastname: Jahn
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D059012:Lost to Follow-Up; D008295:Malawi / Q000453:epidemiology; D008297:Male; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents