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The Causal Effect of Tracing by Peer Health Workers on Return to Clinic Among Patients Who Were Lost to Follow-up From Antiretroviral Therapy in Eastern Africa: A 'Natural Experiment' Arising From Surveillance of Lost Patients
- Source :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol 64, iss 11
- Publication Year :
- 2017
- Publisher :
- eScholarship, University of California, 2017.
-
Abstract
- Background. The effect of tracing human immunodeficiency virus (HIV)-infected patients who are lost to follow-up (LTFU) on reengagement has not been rigorously assessed. We carried out an ex post analysis of a surveillance study in which LTFU patients were randomly selected for tracing to identify the effect of tracing on reengagement. Methods. We evaluated HIV-infected adults on antiretroviral therapy who were LTFU (>90 days late for last visit) at 14 clinics in Uganda, Kenya, and Tanzania. A random sample of LTFU patients was selected for tracing by peer health workers. We assessed the effect of selection for tracing using Kaplan-Meier estimates of reengagement among all patients as well as the subset of LTFU patients who were alive, contacted in person by the tracer, and out of care. Results. Of 5781 eligible patients, 991 (17%) were randomly selected for tracing. One year after selection for tracing, 13.3% (95% confidence interval [CI], 11.1%-15.3%) of those selected for tracing returned compared with 10.0% (95% CI, 9.1%-10.8%) of those not randomly selected, an adjusted risk difference of 3.0% (95% CI, .7%-5.3%). Among patients found to be alive, personally contacted, and out of care, tracing increased the absolute probability of return at 1 year by 22% (95% CI, 7.1%-36.2%). The effect of tracing on rate of return to clinic decayed with a half-life of 7.0 days after tracing (95% CI, 2.6 %-12.9%). Conclusions. Tracing interventions increase reengagement, but developing methods for targeting LTFU patients most likely to benefit can make this practice more efficient.
- Subjects :
- 0301 basic medicine
Male
Pediatrics
Psychological intervention
Human immunodeficiency virus (HIV)
HIV Infections
Tracing
medicine.disease_cause
Ambulatory Care Facilities
Tanzania
Medical and Health Sciences
0302 clinical medicine
Uganda
030212 general & internal medicine
biology
Absolute risk reduction
Biological Sciences
Infectious Diseases
Epidemiological Monitoring
HIV/AIDS
Female
Infection
Microbiology (medical)
Adult
medicine.medical_specialty
retention
Anti-HIV Agents
Health Personnel
antiretroviral therapy
Microbiology
03 medical and health sciences
Clinical Research
East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium
medicine
Humans
Lost to follow-up
loss to follow-up
business.industry
Prevention
biology.organism_classification
030112 virology
Antiretroviral therapy
Kenya
Confidence interval
Good Health and Well Being
Africa
Optometry
Lost to Follow-Up
business
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol 64, iss 11
- Accession number :
- edsair.doi.dedup.....220287722af0576ad83465108c1d4940