title: Outcomes and associated risk factors of patients traced after being lost to follow-up from antiretroviral treatment in Lilongwe, Malawi.
abstract: BACKGROUND
  Loss to follow-up is a major challenge of antiretroviral treatment (ART) programs in sub-Saharan Africa. Our objective was to a) determine true outcomes of patients lost to follow-up (LTFU) and b) identify risk factors associated with successful tracing and deaths of patients LTFU from ART in a large public sector clinic in Lilongwe, Malawi.
  
  
  METHODS
  Patients who were more than 2 weeks late according to their last ART supply and who provided a phone number or address in Lilongwe were eligible for tracing. Their outcomes were updated and risk factors for successful tracing and death were examined.
  
  
  RESULTS
  Of 1800 patients LTFU with consent for tracing, 724 (40%) were eligible and tracing was successful in 534 (74%): 285 (53%) were found to be alive and on ART; 32 (6%) had stopped ART; and 217 (41%) had died. Having a phone contact doubled tracing success (adjusted odds ratio, aOR = 2.1, 95% CI 1.4-3.0) and odds of identifying deaths [aOR = 1.8 (1.2-2.7)] in patients successfully traced. Mortality was higher when ART was fee-based at initiation (aOR = 2.3, 95% CI 1.1-4.7) and declined with follow-up time on ART. Limiting the analysis to patients living in Lilongwe did not change the main findings.
  
  
  CONCLUSIONS
  Ascertainment of contact information is a prerequisite for tracing, which can reveal outcomes of a large proportion of patients LTFU. Having a phone contact number is critical for successful tracing, but further research should focus on understanding whether phone tracing is associated with any differential reporting of mortality or LTFU.
authors.affiliation: Lighthouse Trust at Kamuzu Central Hospital and Ministry of Health, Lilongwe, Malawi. r_weigel@lighthouse.org.mw
authors.forename: Ralf
authors.initials: R
authors.lastname: Weigel
authors.forename: Mindy
authors.initials: M
authors.lastname: Hochgesang
authors.forename: Martin Wg
authors.initials: MW
authors.lastname: Brinkhof
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Matt
authors.initials: M
authors.lastname: Boxshall
authors.forename: Eustice
authors.initials: E
authors.lastname: Mhango
authors.forename: Brains
authors.initials: B
authors.lastname: Nkwazi
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.forename: Maggie
authors.initials: M
authors.lastname: Kamlaka
authors.forename: Frederick
authors.initials: F
authors.lastname: Chagwera
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D059012:Lost to Follow-Up; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents