Implementation and Operational Research: Evaluating Outcomes of Patients Lost to Follow-up in a Large Comprehensive Care Treatment Program in Western Kenya
BACKGROUND:Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately, 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients. METHODS:LTFU was de...
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| Veröffentlicht in: | Journal of acquired immune deficiency syndromes (1999) 2015-04, Vol.68 (4), p.e46-e55 |
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| container_title | Journal of acquired immune deficiency syndromes (1999) |
| container_volume | 68 |
| creator | Rachlis, Beth Ochieng, Daniel Geng, Elvin Rotich, Elyne Ochieng, Vincent Maritim, Beryl Ndege, Samson Naanyu, Violet Martin, Jeffrey N Keter, Alfred Ayuo, Paul Diero, Lameck Nyambura, Monicah Braitstein, Paula |
| description | BACKGROUND:Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately, 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients.
METHODS:LTFU was defined as missing a scheduled visit by ≥3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status.
RESULTS:Of 14,811 LTFU patients, 2540 were randomly selected for tracing (2179 adults, 1071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died, whereas 29% had disengaged from care for various reasons. The remaining patients had moved away (n = 458, 25%) or were still receiving HIV care (n = 443 total, 25%).
CONCLUSIONS:Our findings demonstrate the feasibility of a large-scale sampling-based approach. A significant proportion of patients were found not to be LTFU, and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences. |
| doi_str_mv | 10.1097/QAI.0000000000000492 |
| format | Article |
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METHODS:LTFU was defined as missing a scheduled visit by ≥3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status.
RESULTS:Of 14,811 LTFU patients, 2540 were randomly selected for tracing (2179 adults, 1071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died, whereas 29% had disengaged from care for various reasons. The remaining patients had moved away (n = 458, 25%) or were still receiving HIV care (n = 443 total, 25%).
CONCLUSIONS:Our findings demonstrate the feasibility of a large-scale sampling-based approach. A significant proportion of patients were found not to be LTFU, and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences.</description><identifier>ISSN: 1525-4135</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0000000000000492</identifier><identifier>PMID: 25692336</identifier><identifier>CODEN: JDSRET</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adolescent ; Adult ; Antiretroviral drugs ; Child ; Child, Preschool ; Clinical outcomes ; Comparative analysis ; Drug therapy ; Female ; Health care access ; HIV ; HIV Infections - drug therapy ; Human immunodeficiency virus ; Humans ; Infant ; Infant, Newborn ; Kenya ; Lost to Follow-Up ; Male ; Middle Aged ; Young Adult</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2015-04, Vol.68 (4), p.e46-e55</ispartof><rights>Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright Lippincott Williams & Wilkins Apr 1, 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2077-2c9af73035954cfa58fa65580a5fbd4bf091c278c9eb738cf88211aab0b726563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00126334-201504010-00017$$EHTML$$P50$$Gwolterskluwer$$H</linktohtml><link.rule.ids>314,776,780,4595,27901,27902,65206</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25692336$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rachlis, Beth</creatorcontrib><creatorcontrib>Ochieng, Daniel</creatorcontrib><creatorcontrib>Geng, Elvin</creatorcontrib><creatorcontrib>Rotich, Elyne</creatorcontrib><creatorcontrib>Ochieng, Vincent</creatorcontrib><creatorcontrib>Maritim, Beryl</creatorcontrib><creatorcontrib>Ndege, Samson</creatorcontrib><creatorcontrib>Naanyu, Violet</creatorcontrib><creatorcontrib>Martin, Jeffrey N</creatorcontrib><creatorcontrib>Keter, Alfred</creatorcontrib><creatorcontrib>Ayuo, Paul</creatorcontrib><creatorcontrib>Diero, Lameck</creatorcontrib><creatorcontrib>Nyambura, Monicah</creatorcontrib><creatorcontrib>Braitstein, Paula</creatorcontrib><title>Implementation and Operational Research: Evaluating Outcomes of Patients Lost to Follow-up in a Large Comprehensive Care Treatment Program in Western Kenya</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>BACKGROUND:Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately, 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients.
METHODS:LTFU was defined as missing a scheduled visit by ≥3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status.
RESULTS:Of 14,811 LTFU patients, 2540 were randomly selected for tracing (2179 adults, 1071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died, whereas 29% had disengaged from care for various reasons. The remaining patients had moved away (n = 458, 25%) or were still receiving HIV care (n = 443 total, 25%).
CONCLUSIONS:Our findings demonstrate the feasibility of a large-scale sampling-based approach. A significant proportion of patients were found not to be LTFU, and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Antiretroviral drugs</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical outcomes</subject><subject>Comparative analysis</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Health care access</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Kenya</subject><subject>Lost to Follow-Up</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Young Adult</subject><issn>1525-4135</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkd1u1DAQhSMEoqXwBghZ4oabFP875q5atbBipS2oiMto4p3spjhxsJOu-iy8LF5aftQrfGPP6DtnrDlF8ZLRU0atefvpbHlK_z3S8kfFMbNSlqaq5OP8VlyVkgl1VDxL6ZpSpqW0T4sjrrTlQujj4seyHz32OEwwdWEgMGzIesT4qwJPPmNCiG73jpzfgJ9ze9iS9Ty50GMioSWXuZXViaxCmsgUyEXwPuzLeSRdtiMriFski9CPEXc4pO4mVxCRXEWE6TCYXMawjdAf-K-YJowD-YjDLTwvnrTgE764v0-KLxfnV4sP5Wr9frk4W5WOU2NK7iy0RlChrJKuBVW1oJWqKKi22cimpZY5bipnsTGicm1VccYAGtoYrpUWJ8WbO98xhu9z_kHdd8mh9zBgmFPNtNFCyUrK_0CVEVwyqzL6-gF6HeaYd3qgNGXMam4yJe8oF0NKEdt6jF0P8bZmtD7kXOec64c5Z9mre_O56XHzR_Q72L----DzRtM3P-8x1jsEP-2yH-NaCFlyyhSVlNEyGzMjfgIvdLMq</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Rachlis, Beth</creator><creator>Ochieng, Daniel</creator><creator>Geng, Elvin</creator><creator>Rotich, Elyne</creator><creator>Ochieng, Vincent</creator><creator>Maritim, Beryl</creator><creator>Ndege, Samson</creator><creator>Naanyu, Violet</creator><creator>Martin, Jeffrey N</creator><creator>Keter, Alfred</creator><creator>Ayuo, Paul</creator><creator>Diero, Lameck</creator><creator>Nyambura, Monicah</creator><creator>Braitstein, Paula</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7T5</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Implementation and Operational Research: Evaluating Outcomes of Patients Lost to Follow-up in a Large Comprehensive Care Treatment Program in Western Kenya</title><author>Rachlis, Beth ; Ochieng, Daniel ; Geng, Elvin ; Rotich, Elyne ; Ochieng, Vincent ; Maritim, Beryl ; Ndege, Samson ; Naanyu, Violet ; Martin, Jeffrey N ; Keter, Alfred ; Ayuo, Paul ; Diero, Lameck ; Nyambura, Monicah ; Braitstein, Paula</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2077-2c9af73035954cfa58fa65580a5fbd4bf091c278c9eb738cf88211aab0b726563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Antiretroviral drugs</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical outcomes</topic><topic>Comparative analysis</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Health care access</topic><topic>HIV</topic><topic>HIV Infections - drug therapy</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Kenya</topic><topic>Lost to Follow-Up</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rachlis, Beth</creatorcontrib><creatorcontrib>Ochieng, Daniel</creatorcontrib><creatorcontrib>Geng, Elvin</creatorcontrib><creatorcontrib>Rotich, Elyne</creatorcontrib><creatorcontrib>Ochieng, Vincent</creatorcontrib><creatorcontrib>Maritim, Beryl</creatorcontrib><creatorcontrib>Ndege, Samson</creatorcontrib><creatorcontrib>Naanyu, Violet</creatorcontrib><creatorcontrib>Martin, Jeffrey N</creatorcontrib><creatorcontrib>Keter, Alfred</creatorcontrib><creatorcontrib>Ayuo, Paul</creatorcontrib><creatorcontrib>Diero, Lameck</creatorcontrib><creatorcontrib>Nyambura, Monicah</creatorcontrib><creatorcontrib>Braitstein, Paula</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rachlis, Beth</au><au>Ochieng, Daniel</au><au>Geng, Elvin</au><au>Rotich, Elyne</au><au>Ochieng, Vincent</au><au>Maritim, Beryl</au><au>Ndege, Samson</au><au>Naanyu, Violet</au><au>Martin, Jeffrey N</au><au>Keter, Alfred</au><au>Ayuo, Paul</au><au>Diero, Lameck</au><au>Nyambura, Monicah</au><au>Braitstein, Paula</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation and Operational Research: Evaluating Outcomes of Patients Lost to Follow-up in a Large Comprehensive Care Treatment Program in Western Kenya</atitle><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle><addtitle>J Acquir Immune Defic Syndr</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>68</volume><issue>4</issue><spage>e46</spage><epage>e55</epage><pages>e46-e55</pages><issn>1525-4135</issn><eissn>1944-7884</eissn><coden>JDSRET</coden><abstract>BACKGROUND:Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately, 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients.
METHODS:LTFU was defined as missing a scheduled visit by ≥3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status.
RESULTS:Of 14,811 LTFU patients, 2540 were randomly selected for tracing (2179 adults, 1071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died, whereas 29% had disengaged from care for various reasons. The remaining patients had moved away (n = 458, 25%) or were still receiving HIV care (n = 443 total, 25%).
CONCLUSIONS:Our findings demonstrate the feasibility of a large-scale sampling-based approach. A significant proportion of patients were found not to be LTFU, and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>25692336</pmid><doi>10.1097/QAI.0000000000000492</doi></addata></record> |
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| source | MEDLINE; Journals@Ovid LWW Legacy Archive; Free E- Journals; Journals@Ovid Complete |
| subjects | Adolescent Adult Antiretroviral drugs Child Child, Preschool Clinical outcomes Comparative analysis Drug therapy Female Health care access HIV HIV Infections - drug therapy Human immunodeficiency virus Humans Infant Infant, Newborn Kenya Lost to Follow-Up Male Middle Aged Young Adult |
| title | Implementation and Operational Research: Evaluating Outcomes of Patients Lost to Follow-up in a Large Comprehensive Care Treatment Program in Western Kenya |
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