BACKGROUND: In 2011 an experienced HIV nurse from the UK was
deployed for 3 months to act as a mentor to nurses learning to
initiate antiretroviral therapy (ART) in primary care clinics in a
small town in the Eastern Cape, South Africa.
METHODS: A review of existing pre-ART patient files (N=286)
was carried out and lost-to-follow-up (LTFU) HIV patients were
RESULTS: Only 24% of patients had attended the clinics within the
preceding 6 months and 20% had not attended for longer than 2
years. Two lay counsellors visited 222 patients to encourage them
to return to care; 65/286 (23%) were untraceable, 11/286 (4%) had
relocated, 30/286 (10%) declined, and 8/286 (3%) had died. In the 6
weeks following recall, 51/286 patients (18%) returned to the clinics.
CD4 count testing was repeated and screening for tuberculosis (TB)
and other opportunistic infections was performed for all patients;
ART was initiated in 13/51 (25%), 1 patient tested positive for TB,
and isionazid (INH) prophylaxis was initiated in 23/51 (45%). The
cost of recall was R130/patient. Within 6 months, all clinics began
providing full ART services, 17 professional nurses were mentored
and they initiated ART in 55 patients.
CONCLUSIONS: Mentoring plays an important role in professional
nurse training and support. Recall of LTFU patients is feasible and
effective in improving ART services in rural settings.