Preliminary data from
the
LTFU Study
Thursday 23rd Feb 2012 At FACES Conference Hall
Objective
• To share the preliminary data
from the LTFU Study during
Client Retention Meeting at
Lumumba-FACES
Thursday 23rd Feb 2012 At FACES
Conference Hall
Presentation Outline
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Background
Study process
The Study sample
Back on care after tracking
Self transfers out
Reasons for being LTFU
Thursday 23rd Feb 2012 At FACES
Conference Hall
Background
• Many patients enrolled in HIV
programs become LTFU
• As many as 40% at 5 years
have unknown outcomes
Thursday 23rd Feb 2012 At FACES
Conference Hall
Background
• The total number of LTFU in
the CCP of FACES according to
the study are x.
• We don’t know what happens
to these patients
Thursday 23rd Feb 2012 At FACES
Conference Hall
Background
Have they:
•“Self transferred” to a new clinic?
•“Disengaged” – stopped going to
any clinic?
• Died?
Thursday 23rd Feb 2012 At FACES
Conference Hall
Because at a patient level:
• If they have self transferred to
another clinic, we want to know why.
• We want to update our records as a
transfer.
• We can use information on why they
transferred to improve clinic
services.
Thursday 23rd Feb 2012 At FACES
Conference Hall
Because at a patient level:
• If they have stopped care
all together, we want to
provide services and
counseling to encourage
them to re-enter care.
Thursday 23rd Feb 2012 At FACES
Conference Hall
Because at a patient level:
• If they have died, we want to
understand why the urgent illness
before their death wasn’t identified
and treated.
• We can use this information to
design better clinic services.
Thursday 23rd Feb 2012 At FACES
Conference Hall
Because at a clinic level:
If we don’t know what happened to these
people we don’t know how our clinic is doing
• How many people registered in this clinic have
actually died? More than are reported to
clinic.
• How many people are actually still in care ?
More than are reported as transfers to clinic.
Thursday 23rd Feb 2012 At FACES
Conference Hall
Because at a clinic level:
To improve care we need to know:
• Why do patients stop coming?
• Why do patients transfer to other clinics?
• How can we support patients in staying in
care?
• How do we identify and help patients who are
at higher risk of death if they default from
care?
Thursday 23rd Feb 2012 At FACES
Conference Hall
The sample
• Too many people are LTFU to find
them all.
• A random sampling to represent the
LTFU population
Thursday 23rd Feb 2012 At FACES
Conference Hall
The sample and study Area
• The is going on in 4 study sites In Kisumu East
District:
Site
Sample
Lumumba
234
Pandpieri
109
Tuungane
67
FHOK
57
Total
467
Thursday 23rd Feb 2012 At FACES
Conference Hall
Who have been doing the LTFU
Tracking?
• CCHAs attached to the study
and had also been doing
defaulter tracing in the
program.
Thursday 23rd Feb 2012 At FACES
Conference Hall
Tracking process-Ongoing
• Involves Intensive tracking of each patient in
the sample until an outcome is found in all the
sites.
• The tracker gets the contact information from
the patient’s file at the clinic and tracks
• Ask patients or informants the reasons why
they are lost to follow up
Thursday 23rd Feb 2012 At FACES
Conference Hall
Tracking success
Sample
Total Sample
Total tracked
Successful
outcome
Number
467
460
423
Percentage
100%
98.5%
90.5%
Thursday 23rd Feb 2012 At FACES
Conference Hall
Some reasons for being LTFU
a)Provider related reasons
• Many are branded LTFU when
they are actually not due to lack
of documentation.
-2 levels
• Care is better at the new clinic
Thursday 23rd Feb 2012 At FACES
Conference Hall
Some reasons for being LTFU
a)Provider related reasons….Cont
• Afraid to be scolded for missing TCA
• Clinic staff nicer at the new site
• Did not want to be sent to defaulter
class
• Avoiding to come with treatment
buddies
Thursday 23rd Feb 2012 At FACES
Conference Hall
Some reasons for being LTFU
b) Client
Related reasons
• Family conflicts eg divorce
• Family obligations eg ladies who
get married
• Spending less money on
transport cost
Thursday 23rd Feb 2012 At FACES
Conference Hall
Some reasons for being LTFU
b) Client Related reasons....conts
• Spending less time at the new
clinic
• New clinic is closer to place of
work
• Avoiding to meet people who
know them at the clinic (Stigma)
Thursday 23rd Feb 2012 At FACES
Conference Hall
Outcome of the study
• 182 transferred
themselves out
Thursday 23rd Feb 2012 At FACES
Conference Hall
Study Outcome
36%
Returned to Care
Unsuccessfully Attempted
to come back
52%
Promised to come but
have not come
12%
Thursday 23rd Feb 2012 At FACES
Conference Hall
Case study From Pandpieri Site
• Earlier visited as a defaulter- 5home visits
• Some times she was not at found at home,
when she was found she gave a reason of not
being able to come with a treatment buddy
• Promised to come back, but did not
• Tracked during LTFU study and was convinced
to come back to the clinic
• Came back 2 days after tracking without a
buddy and was sent back again to get a buddy.
• Has never come back.
Thursday 23rd Feb 2012 At FACES
Conference Hall
What lessons have
we learnt?
Thursday 23rd Feb 2012 At FACES
Conference Hall
END
Any questions?
Thursday 23rd Feb 2012 At FACES
Conference Hall