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Patterns of ART re-uptake

Patterns of ART re-uptake. The effectiveness of the Back-to-Care program in Lilongwe, Malawi. J. Lübbert, H. Tweya, T. Chaweza , J. Mwafilaso , A. Jahn, P. Schnitzler, S. Phiri, F. Neuhann. Background. Located in Malawi‘s capital : Lilongwe Operates 2 day hospitals :

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Patterns of ART re-uptake

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  1. Patterns of ART re-uptake The effectiveness of the Back-to-Careprogram in Lilongwe, Malawi J. Lübbert, H. Tweya, T. Chaweza, J. Mwafilaso, A. Jahn, P. Schnitzler, S. Phiri, F. Neuhann

  2. Background • Located in Malawi‘s capital: Lilongwe • Operates 2 dayhospitals: • LighthouseClinic • Martin Preuss Centre • Since 2004: Free accessto ART in thepublicsector • Largest public sector ART provider in central region • > 14,000 patients enrolled in ART Program in 2008-2009 • Established electronic data system (EDS) for routine collection of ART data

  3. Aims & objectives Aim: Evaluation of an early active follow up strategyto improve retention in care Objectives: Identification of ART re-uptake patterns among patients with or without intervention of the program Clarification of reasons for missed appointments (current ART status)

  4. Approach & studypopulation Approach: • Descriptiveretrospectivestudy Study population - inclusioncriteria: • Enrolled in ART Program • January 2008 - December 2009 • Age >15 years

  5. Back-to-careprogram (B2C) Established: July 2006 Function:Identification and early active follow up of patients with missed appointments EDS B2C team Outcomes

  6. Outcome: Reasons for missed appointments

  7. B2C: earlyactivefollowup 2008/2009 Defaulter 421 545 595 (34%) 1,137(66%) 171 1,732 Discontinued ART Continued ART Dead Confirmedmissedappointments* Not contacted Contacted B2C program Outcome ? Return toclinic 313 112 425 171 37% vs. 29% (p<0.01) * Excluding documented transfer outs

  8. Contactsuccess & returndynamics 425171

  9. Appointmentgiven & returndynamics

  10. Gender andreturn ♂ ♀

  11. Key observations • Patients contacted by the B2C program were more likely to return to the clinic • The contact of the B2C program and scheduled appointments were associated with early return to the clinic • Men were more likely to default, whilst women were more likely to return to the clinic. • ART outcome information about: • Reasons for missed appointments • Mortality rates • Patient shifting within the health system

  12. Conclusions The B2C program is a successful early active follow up initiative needs to improve contact information provides outcome information for future improvement based on informed decision making

  13. Acknowledgements Dr. Sam Phiri Mr. Hannock Tweya andteam Mr. Thom Chaweza B2C team Staff (Lighthouseand Martin Preuss) Prof. Paul Schnitzler Dr. Florian Neuhann Thankyouverymuchforyourattention!

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