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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Community-based follow-up for late patients enrolled in a district-wide programme for antiretroviral therapy in Lusaka, Zambia
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, Volume 20, No. 3, Year 2008
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Description
Timely adherence to clinical and pharmacy appointments is well correlated with favourable patient outcomes among HIV-infected individuals on antiretroviral therapy. To date, however, there is little work exploring reasons behind missed visits or evaluating programmatic strategies to recall patients. For this study we implemented community-based follow-up of late patients as part of a large-scale programme for HIV care and treatment in Lusaka, Zambia. Through a network of local home-based care organizations, we attempted home visits to recall patients using locator information provided at time of enrolment. Between May and September 2005, home-based caregivers were dispatched to trace 1,343 patients with missed appointments. Of these, 554 (41%) were untraceable because the provided address was invalid, the patient had moved or no one was at the home. Of the remaining 789, 359 (46%) were reported to have died. Only 430 (54% of those traced, 32% overall) were contacted directly and encouraged to return for care. The likelihood of patient return was higher among traced patients in crude analysis (relative risk [RR] = 2.5; 95%CI = 1.9-3.2) and in multivariable analysis controlling for baseline body mass index, sex and CD4 + count ≤ 50/μL (adjusted RR = 2.3; 95%CI = 1.7-3.2). However, the process was inefficient: one late patient returned for every 18 home visits that were made. Reasons for missed visits were provided in 271 of 430 (63%) of the patients who were successfully traced. Common reasons included feeling too sick to come to the clinic, travelling away from home and being too busy. Despite the availability of free ART in Lusaka, patients face significant barriers to attending scheduled clinical visits. Cost-effective and feasible strategies are urgently needed to improve timely patient follow-up. © 2008 Taylor & Francis.
Authors & Co-Authors
Krebs, Daniel W.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Chi, Benjamin H.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Mulenga, Yvonne
Zambia, Lusaka
Project Concern International
Morris, Mary B.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Cantrell, Ronald A.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Mulenga, Lloyd Berdad
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Levy, Jens W.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Sinkala, Moses M.
Zambia, Lusaka
Zambian Ministry of Health
Stringer, Jeffrey S.A.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Statistics
Citations: 9
Authors: 9
Affiliations: 4
Identifiers
Doi:
10.1080/09540120701594776
ISSN:
09540121
e-ISSN:
13600451
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
Zambia