title: Tracing patients on antiretroviral treatment lost-to-follow-up in an urban slum in India.
abstract: OBJECTIVE
  This article describes a cooperative initiative between an HIV-clinic and non-government organization network providing lost-to-follow-up tracing and delayed appointment follow-up of patients on antiretroviral treatment.
  
  
  BACKGROUND
  Loss-to-follow-up among patients on antiretroviral treatment is a major challenge in resource-constrained settings. A model of cooperation between a Médecins Sans Frontières HIV-clinic and a non-governmental-organization network was piloted in a Mumbai slum. A steady decline in delayed appointments and loss-to-follow-up was observed over 4 years.
  
  
  METHODS
  Mixed method study.
  
  
  METHODS
  A study conducted in January 2011 explored potential reasons for declining loss-to-follow-up-rates. A retrospective, quantitative analysis of patient data was undertaken complemented by 22 semi-structured interviews, four focus-group discussions to explore patients' and providers' perceptions of tracing activities.
  
  
  RESULTS
  The clinic loss-to-follow-up-rate has steadily declined from mid-2008-2011. Thirty-eight (4·6%) of 819 patients registered during the period were lost-to-follow-up with most lost during the first year. Rates of loss-to-follow-up between 0·3-2·4% were observed over the last 2 years. Phoning the day before an appointment was perceived as the most useful intervention to avoid missing appointments. The analysis revealed a widespread fear of forced disclosure by patients during home visits.
  
  
  CONCLUSIONS
  The low loss-to-follow-up-rate cannot be attributed to the network tracing activities alone. Phoning before appointments may result in fewer delayed appointments and prevent loss-to-follow-up. Home visits should be a last resort method of patient tracing because of the risk of HIV-status disclosure and the opportunity of discrimination from family and neighbours.
authors.affiliation: Médecins Sans Frontières, Mumbai, India.
authors.forename: Lisa
authors.initials: L
authors.lastname: Errol
authors.forename: Petros
authors.initials: P
authors.lastname: Isaakidis
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ali
authors.forename: Gurudas
authors.initials: G
authors.lastname: Pilankar
authors.forename: Sanjana
authors.initials: S
authors.lastname: Maurya
authors.forename: Claudia
authors.initials: C
authors.lastname: Geraets
authors.forename: Joanna
authors.initials: J
authors.lastname: Ladomirska
authors.forename: Sunil
authors.initials: S
authors.lastname: Patel
authors.forename: Tony
authors.initials: T
authors.lastname: Reid
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001071:Appointments and Schedules; D019058:Community Networks; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007194:India; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011204:Poverty Areas; D012189:Retrospective Studies; D057545:Social Stigma
chemical_list: D019380:Anti-HIV Agents