Implementation and outcomes of an active defaulter tracing system for HIV, prevention of mother to child transmission of HIV (PMTCT), and TB patients in Kibera, Nairobi, Kenya

Médecins Sans Frontières (MSF) Operational Centre Brussels, PO BOX 38897 Postal Code 00623, Parklands, Nairobi, Kenya.
Transactions of the Royal Society of Tropical Medicine and Hygiene (Impact Factor: 1.84). 06/2011; 105(6):320-6. DOI: 10.1016/j.trstmh.2011.02.011
Source: PubMed


Retention of patients in long term care and adherence to treatment regimens are a constant challenge for HIV, prevention of mother to child transmission of HIV (PMTCT), and TB programmes in sub-Saharan Africa. This study describes the implementation and outcomes of an active defaulter tracing system used to reduce loss to follow-up (LTFU) among HIV, PMTCT, TB, and HIV/TB co-infected patients receiving treatment at three Médecins Sans Frontières clinics in the informal settlement of Kibera, Nairobi, Kenya. Patients are routinely contacted by a social worker via telephone, in-person visit, or both very soon after they miss an appointment. Patient outcomes identified through 1066 tracing activities conducted between 1 April 2008 and 31 March 2009 included: 59.4% returned to the clinic, 9.0% unable to return to clinic, 6.3% died, 4.7% refused to return to clinic, 4.5% went to a different clinic, and 0.8% were hospitalized. Fifteen percent of patients identified for tracing could not be contacted. LTFU among all HIV patients decreased from 21.2% in 2006 to 11.5% in 2009. An active defaulter tracing system is feasible in a resource poor setting, solicits feedback from patients, retains a mobile population of patients in care, and reduces LTFU among HIV, PMTCT, and TB patients.

86 Reads
  • Source
    • "Defaulter tracing of the HEIs is often difficult, a finding reported elsewhere [21] [22] [23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Gaps exist in coverage, early access, and utilization of prevention of mother-to-child transmission of HIV (PMTCT) services in Kenya. The Maternal and Child Health Integrated Program, led by Jhpiego, piloted an adaptation of immunization's Reaching Every District (RED) approach in Bondo District as a way of improving PMTCT care. Routine district-level monthly summary service delivery pre- and post-implementation data were analyzed. Marked improvements resulted in the proportion of HIV-infected and non-infected pregnant women completing four focused prenatal care visits, from 25% to 41%, and the proportion of HIV-exposed infants (HEIs) tested at six weeks, from 27% to 78% (P<0.001). The proportion of HEIs tested for HIV infection at 12months was 52%, while 77% of HEIs were issued antiretroviral prophylaxis by the end of the pilot. Implementation of RED for PMTCT demonstrated that PMTCT services can be delivered effectively in the context of the existing community strategy and resulted in increased coverage, access, and utilization of care for HIV-positive pregnant women and their children. Copyright © 2015. Published by Elsevier Ireland Ltd.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 06/2015; 130 Suppl 2:S68-S73. DOI:10.1016/j.ijgo.2015.04.002 · 1.54 Impact Factor
  • Source
    • "In addition, 15 on-going trials investigating interventions to improve linkage and retention in pre-ART care were identified. Four publications with potentially relevant data could not be included as authors were unable to provide relevant data [18,24,33,34]. Characteristics of the included studies are summarized in Tables 1 and 2. Twenty studies were published in peer reviewed journals, one was an unpublished study and three were conference abstracts. "
    [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionSeveral approaches have been taken to reduce pre-antiretroviral therapy (ART) losses between HIV testing and ART initiation in low- and middle-income countries, but a systematic assessment of the evidence has not yet been undertaken. The aim of this systematic review is to assess the potential for interventions to improve or facilitate linkage to or retention in pre-ART care and initiation of ART in low- and middle-income settings.MethodsAn electronic search was conducted on Medline, Embase, Global Health, Web of Science and conference databases to identify studies describing interventions aimed at improving linkage to or retention in pre-ART care or initiation of ART. Additional searches were conducted to identify on-going trials on this topic, and experts in the field were contacted. An assessment of the risk of bias was conducted. Interventions were categorized according to key domains in the existing literature. ResultsA total of 11,129 potentially relevant citations were identified, of which 24 were eligible for inclusion, with the majority (n=21) from sub-Saharan Africa. In addition, 15 on-going trials were identified. The most common interventions described under key domains included: health system interventions (i.e. integration in the setting of antenatal care); patient convenience and accessibility (i.e. point-of-care CD4 count (POC) testing with immediate results, home-based ART initiation); behaviour interventions and peer support (i.e. improved communication, patient referral and education) and incentives (i.e. food support). Several interventions showed favourable outcomes: integration of care and peer supporters increased enrolment into HIV care, medical incentives increased pre-ART retention, POC CD4 testing and food incentives increased completion of ART eligibility screening and ART initiation. Most studies focused on the general adult patient population or pregnant women. The majority of published studies were observational cohort studies, subject to an unclear risk of bias.ConclusionsFindings suggest that streamlining services to minimize patient visits, providing adequate medical and peer support, and providing incentives may decrease attrition, but the quality of the current evidence base is low. Few studies have investigated combined interventions, or assessed the impact of interventions across the HIV cascade. Results from on-going trials investigating POC CD4 count testing, patient navigation, rapid ART initiation and mobile phone technology may fill the quality of evidence gap. Further high-quality studies on key population groups are required, with interventions informed by previously reported barriers to care.
    Journal of the International AIDS Society 08/2014; 17(1):19032. DOI:10.7448/IAS.17.1.19032 · 5.09 Impact Factor
  • Source
    • "Home visits and community outreach are often employed as methods to optimize treatment adherence among TB patients. Previous research has consistently demonstrated the effectiveness of such patient tracing activities in returning patients to care and improving final treatment outcomes [6-11]. However, the ability to conduct these activities may be constrained by limitations in human and logistic resources, particularly in resource-limited settings with a high TB burden. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In 2008--2009 the South African National Tuberculosis (TB) Program (NTP) implemented a national pilot project, the TB Tracer Project, aiming to decrease default rates and improve patient outcomes. The current study aimed to inform the NTP by describing the knowledge, attitudes, and practices of TB program personnel involved with tracing activities. A self-administered written questionnaire was sent to TB staff, managers and tracer team leaders to assess basic TB knowledge, attitudes and practices. Descriptive statistics were used to summarize results and the chi-squared statistic was used to compare responses of staff at facilities that participated in the TB Tracer Project (tracer) and those that followed standard NTP care (non-tracer). Of 560 total questionnaires distributed, 270 were completed and returned (response rate 48%). Total TB knowledge ranged from 70.8-86.3% correct across all response groups. However, just over half (range 50--59.3%) of each respondent group was able to correctly identify the four components of a DOT encounter. A patient no longer feeling sick was cited by 72.1% of respondents as the reason patients fail to adhere to treatment. Tracer teams were viewed as an effective means to get patients to return to treatment by 96.3% of health facility level respondents. Tracer team leaders reported concerns including lack of logistical support (41.7%), insufficient physical safety precautions (41.7%), and inadequate protection from contracting TB (39.1%). Upon patients returning to treatment at the clinic, facilities included in the TB Tracer Project were significantly more likely to discuss alternate DOTS arrangements than non-tracer facilities (79.2 vs. 66.4%, p = 0.03). This study identified key components of knowledge, attitudes, and practices regarding TB patient tracing activities in South Africa. Educating patients on the essential need to complete treatment irrespective of clinical symptoms may help improve treatment adherence. Future scale-up and integration of TB tracing activities as part of standard TB management should include provisions for standardized training of personnel on the critical elements of DOTS, and for ensuring appropriate supervision, logistical support, and physical safety and TB transmission protection of tracing teams.
    BMC Public Health 09/2013; 13(1):801. DOI:10.1186/1471-2458-13-801 · 2.26 Impact Factor
Show more


86 Reads
Available from