title: Implementation and outcomes of an active defaulter tracing system for HIV, prevention of mother to child transmission of HIV (PMTCT), and TB patients in Kibera, Nairobi, Kenya.
abstract: Retention of patients in long term care and adherence to treatment regimens are a constant challenge for HIV, prevention of mother to child transmission of HIV (PMTCT), and TB programmes in sub-Saharan Africa. This study describes the implementation and outcomes of an active defaulter tracing system used to reduce loss to follow-up (LTFU) among HIV, PMTCT, TB, and HIV/TB co-infected patients receiving treatment at three Médecins Sans Frontières clinics in the informal settlement of Kibera, Nairobi, Kenya. Patients are routinely contacted by a social worker via telephone, in-person visit, or both very soon after they miss an appointment. Patient outcomes identified through 1066 tracing activities conducted between 1 April 2008 and 31 March 2009 included: 59.4% returned to the clinic, 9.0% unable to return to clinic, 6.3% died, 4.7% refused to return to clinic, 4.5% went to a different clinic, and 0.8% were hospitalized. Fifteen percent of patients identified for tracing could not be contacted. LTFU among all HIV patients decreased from 21.2% in 2006 to 11.5% in 2009. An active defaulter tracing system is feasible in a resource poor setting, solicits feedback from patients, retains a mobile population of patients in care, and reduces LTFU among HIV, PMTCT, and TB patients.
authors.affiliation: Médecins Sans Frontières (MSF) Operational Centre Brussels, PO BOX 38897 Postal Code 00623, Parklands, Nairobi, Kenya. thomson.kerry@gmail.com
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Thomson
authors.forename: Erastus O
authors.initials: EO
authors.lastname: Cheti
authors.forename: Tony
authors.initials: T
authors.lastname: Reid
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D016358:Contact Tracing / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D007630:Kenya / Q000453:epidemiology; D059012:Lost to Follow-Up; D008297:Male; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D014798:Vital Statistics; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents