title: Patients who return to care after tracking remain at high risk of attrition: experience from a large HIV clinic, Uganda.
abstract: We determined the retention rate of patients infected with HIV who resumed care after being tracked at the Infectious Diseases Clinic (IDC) in Kampala, Uganda. Between April 2011 and September 2013, patients who missed their clinic appointment for 8-90 days were tracked, and those who returned to the clinic within 120 days were followed up. The proportion of patients retained among tracked patients, and those who resumed care before tracking started was compared. At 18 months of follow up, 33 (39%) of the tracked patients and 72 (61%) of those who had resumed care before tracking started were retained in care. The most important cause of attrition among the traceable was self-transfer to another clinic (38 [73%] patients), whereas among those who resumed care before tracking was loss to follow up (LTFU) (32 [71%] patients). Tracked patients who resume care following a missed appointment are at high risk of attrition. To increase retention, antiretroviral therapy clinics need to adopt a chronic care model which takes into consideration patients' changing needs and their preference for self-management.
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda nakiwoalice@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Nakiwogga-Muwanga
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Musaazi
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: E
authors.initials: E
authors.lastname: Katabira
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: W
authors.initials: W
authors.lastname: Worodria
authors.affiliation: Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda.
authors.forename: S Alamo
authors.initials: SA
authors.lastname: Talisuna
authors.affiliation: Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Colebunders
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001071:Appointments and Schedules; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D016312:Treatment Refusal
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; HIV; Uganda; antiretroviral therapy; loss to follow up; missed appointment; patients’ retention; resource-limited setting; resuming care; risk of attrition; tracking; treatment