Adherence & Retention

Thanks for the post, Rebecca.

In Liberia, the National AIDS Control Program has not yet settled on an accepted definition for lost to follow up. We are about to begin a pilot program at our two largest government hospitals using HIV positive peer counselors to trace patients who miss one appointment. This is an aggressive definition of "lost to follow up," but we hope to be as proactive as possible.

An important aspect of this program will be training the peer counselors in what to say to the patients in different situations and experiencing different barriers-- illness, stigma, lack of disclosure to family members, high transportation costs.

Once we get these peer visits started, we will be able to have a better idea of our retention in care figures. More specifically we will be able to differentiate between patients who have decided to stop seeking care, those who moved away and those who have died.

Dear Rebecca,

Your concern about the definition of LTFU is valid because the approach to adherence and retention issues will largely depend on how LTFU is defined. In Nigeria, LTFU is been defined as Patient defaulting up to 3 consecutive months of ARV refill appointment. However, in order to ensure that these patients are not lost we sought to track the patients that are defaulting 1-day after ARV refill appointment. This way, the patients get to come back for their ARV refills the next day. If any patient does not come back the next, we get to track the patients/their next if kin continuously at the end of each month through phone calls and home visits (utilizing the help of the support group members) to ensure that the patients continues the drugs. this means that we have two categories of patients-
..Patient defaulting up to 1-days after ARV refill appointment
..Patient defaulting up to 3 consecutive months of ARV refill appointment who are then tagged as LTFU.

i need to mention also that the success of these tracking depends largely on the ability to retrieve correct contact information from the patients at the point of registration.
The active tracking ...

Dear Rebecca,

Your concern about the definition of LTFU is valid because the approach to adherence and retention issues will largely depend on how LTFU is defined. In Nigeria, LTFU is been defined as Patient defaulting up to 3 consecutive months of ARV refill appointment. However, in order to ensure that these patients are not lost we sought to track the patients that are defaulting 1-day after ARV refill appointment. This way, the patients get to come back for their ARV refills the next day. If any patient does not come back the next, we get to track the patients/their next if kin continuously at the end of each month through phone calls and home visits (utilizing the help of the support group members) to ensure that the patients continues the drugs. this means that we have two categories of patients-
..Patient defaulting up to 1-days after ARV refill appointment
..Patient defaulting up to 3 consecutive months of ARV refill appointment who are then tagged as LTFU.

i need to mention also that the success of these tracking depends largely on the ability to retrieve correct contact information from the patients at the point of registration.
The active tracking of these patients will then lead to the identification and subsequent characterization of the patients into the different reason for default which will support well targeted intervention into ensuring that patients are not lost.The information generated from the tracking can be one or more of the following reason:Known death, Treatment Stop(medical or social reasons), Loss to follow up,Agreed to come back, Self transfer, Self discontinuation, Still had drugs,Wrong phone/address Nos/ Nos not available.
I strongly support the diasggregation of the defaulting patients because it can be a pointer to a defect in the system; such as lapses in adherence counseling...
I will also be happy to have people on this network who have developed better packages for LTFU to share with us.
thanks