title: Implementation and operational research: evaluating outcomes of patients lost to follow-up in a large comprehensive care treatment program in western Kenya.
abstract: BACKGROUND
  Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately, 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients.
  
  
  METHODS
  LTFU was defined as missing a scheduled visit by ≥3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status.
  
  
  RESULTS
  Of 14,811 LTFU patients, 2540 were randomly selected for tracing (2179 adults, 1071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died, whereas 29% had disengaged from care for various reasons. The remaining patients had moved away (n = 458, 25%) or were still receiving HIV care (n = 443 total, 25%).
  
  
  CONCLUSIONS
  Our findings demonstrate the feasibility of a large-scale sampling-based approach. A significant proportion of patients were found not to be LTFU, and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences.
authors.affiliation: *Academic Model Providing Access To Healthcare, Eldoret, Kenya; †Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ‡Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; §Moi University School of Public Health, Kenya; Departments of ‖Behavioral Sciences; and ¶Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
authors.forename: Beth
authors.initials: B
authors.lastname: Rachlis
authors.forename: Daniel
authors.initials: D
authors.lastname: Ochieng
authors.forename: Elvin
authors.initials: E
authors.lastname: Geng
authors.forename: Elyne
authors.initials: E
authors.lastname: Rotich
authors.forename: Vincent
authors.initials: V
authors.lastname: Ochieng
authors.forename: Beryl
authors.initials: B
authors.lastname: Maritim
authors.forename: Samson
authors.initials: S
authors.lastname: Ndege
authors.forename: Violet
authors.initials: V
authors.lastname: Naanyu
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.forename: Alfred
authors.initials: A
authors.lastname: Keter
authors.forename: Paul
authors.initials: P
authors.lastname: Ayuo
authors.forename: Lameck
authors.initials: L
authors.lastname: Diero
authors.forename: Monicah
authors.initials: M
authors.lastname: Nyambura
authors.forename: Paula
authors.initials: P
authors.lastname: Braitstein
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D055815:Young Adult