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Patient tracing and community dispensing of ARVs keep patients in care
Lesley Odendal, 2012-07-24 03:10:00
Physical tracing of patients in antiretroviral (ARV) programmes results in a decrease in loss to follow-up, but an increase in reported mortality, according to a systematic review of low- and middle-income country ARV programmes presented at the 19th International AIDS Conference (AIDS 2012) in Washington DC today.
Retention in care is a serious problem for treatment programmes in sub-Saharan Africa, both among patients not yet eligible for treatment and among those already on treatment. Although there is some evidence to suggest that patient tracing helps to retain patients in care after they miss clinic appointments, there has been no systematic analysis of the experience of treatment programmes in low- and middle-income countries to determine which features of the treatment programme are associated with better retention in care.
The review, by Dr James McMahon of the Alfred Hospital in Melbourne and colleagues, included 32 published papers and 7 conference abstracts to compare summary estimates of loss to follow-up, mortality and retention in low- and middle-income countries 12 months after ARV initiation in cohorts of patients, with and without physical tracing of patients. Physical tracing involves tracking patients to their home address or following up with household members to check where the patient may be found.
According to the review, which involved the analysis of 62,791 people who had started ARVs, from 25 cohorts that carried out patient tracing and 124,875 patients from 29 cohorts that did not practice patient tracing, 7.6% of patients were lost to follow-up in the programmes which included patient tracing, compared to 15.1% in those programmes which did not use physical tracing (p<0.001).
Patient retention on ARVs was higher in physical tracing programmes at 80%, compared to 75.8% in those that did not use physical tracing (p=0.006). In addition, the review found higher retention rates at the original site where the patient began treatment than at those sites where patient tracing was conducted (80% compared to 72.9%).
According to the researchers, this suggests that patient tracing may increase re-engagement in care. However, mortality was higher in the cohorts including physical tracing, at 80%, compared to 75.8 % in those that did not use physical tracing (p=0.04), because it was able to definitively establish that patients had died.
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