Improving retention of clients on antiretroviral therapy through expert patients: Involving people living with HIV in Alebtong District, Northern Uganda
The World Health Organization’s (WHO) Integrated Approach to HIV Prevention, Care, and Treatment (IMAI) recommends adoption of people living with HIV (PLHIV) as community health workers (CHWs) to track patients who have not appeared at the clinic for at least three months (lost to follow-up [LTFU]) through contact tracing (home visits).
Since February 2015, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) project has supported 137 health facilities in 15 northern Uganda districts to implement strategies to engage CHWs to ensure retention of HIV positive clients who are lost to follow up using a quality improvement (QI) approach. ASSIST, in collaboration with the district and health facilities in Alebtong District initiated a QI project to track and re-activate care for PLHIV who had not been seen in the clinic for at least three months at five antiretroviral therapy (ART) centers.
A baseline assessment conducted in January 2016 found only 88% (2591/ 2921) ever enrolled clients were active in care. Facility QI teams came up with an improvement aim to return 100% of the LTFU clients within 3 months and tested changes like: reviewing the ART registers and generating lists of LTFU clients; and assigning each lost client to be followed up by community linkage facilitators (CLF) who reside in the same or nearby village. Results received in April-June 2016 showed that of the 330 LTFU clients, 262 (79%) had been found alive and not on treatment and were brought back to care, 54 (19%) had self-transferred, and 12 (4%) had died. Involving expert clients to track LTFU from their own villages can help to bridge gaps related to retention rates and clients without additional human and financial resources.
Read how David, an expert patient is taking lead in securing a future of people living with HIV at Rachuonyo patient support center in Kenya.