Abstract:
BACKGROUND : Lost to follow-up (LTFU) is a major challenge that hinders the success of
antiretroviral treatment (ART).
OBJECTIVE : To identify factors conducted to a low LTFU rate.
METHODS : We conducted a two-part descriptive and quantitative study. Part 1 comprised
interviews with clinic staff to determine their perspectives on LTFU and to establish the
clinic’s follow-up procedures for patients on ART. Part 2 of the study was a retrospective
review of clinic and patient records. LTFU patients were identified and those with contact
details were contacted for telephonic interview to determine if they were still on ART and/or
their reasons for becoming LTFU.
RESULTS : A low LTFU rate (7.9%; N = 683) was identified. Work-related stress, and lack of
transport and funds were reported reasons for LTFU. Monthly visits, non-adherent defaulters
and LTFU patients were tracked by an electronic system (SOZO). Factors contributing to high
rates of retention in care were: location of the clinic in the inner city, thus in close proximity
to patients’ homes or work; clinic operating on Saturdays, which was convenient for patients
who could not attend during the week; an appointment/booking system that was in place and
strictly adhered to; a reminder SMS being sent out the day before an appointment; individual
counselling sessions at each visit and referrals where necessary; and a stable staff complement
and support group at the clinic.
CONCLUSION : Achieving a low LTFU rate is possible by having a patient-centred approach and
monitoring systems in place.
