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Paul Nambala 1 , Shinsuke Miyano 2 , Kenichi Komada 2,3 ,

Urgent need to strengthen active tracing of lost to follow up cases: a prospective cohort study of newly diagnosed HIV clients in rural districts, Zambia. 1 Kazungula District Community Medical Office, Zambia 2 National Center for Global Health and Medicine, Japan

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Paul Nambala 1 , Shinsuke Miyano 2 , Kenichi Komada 2,3 ,

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  1. Urgent need to strengthen active tracing of lost to follow up cases: a prospective cohort study of newly diagnosed HIV clients in rural districts, Zambia 1Kazungula District Community Medical Office, Zambia 2 National Center for Global Health and Medicine, Japan 3 SHIMA project, JICA, Lusaka, Zambia 4Kalomo District Community Medical Office, Zambia 5 Ministry of Health, Lusaka, Zambia Paul Nambala1, Shinsuke Miyano2, Kenichi Komada2,3, Francis Hadunka1, Vincent Chipeta4, Kenneth Chibwe4, Albert Mwango5

  2. Background: HIV in Zambia • Zambia has a population of 13.2 million (2010) • New infection rate in 2011 - 0.96% among males - 1.25% among females • HIV Prevalence in adults: 14.3% (2007 ZDHS) - Rural 10.3 % - Urban 19.7%

  3. Kazungula and Kalomo District • 480 & 360km south west of Lusaka (Capital city) • Share borders with Zimbabwe, Namibia, Botswana by the Zambezi river. • Total population: 396,390 (2013) • Area: 30,000 km2 • The mainstay is agriculture and animal husbandly with few industry.

  4. HIV in Kazungula/Kalomo • Adult HIV prevalence rate -13.4%. • ART services started in a few selected health facilities in 2005 and have been scaling up. • Number of HIV infected adults on ARVs – 8200.

  5. Objectives • To assess the retention among HIV testing, care and treatment. • To evaluate active tracing for lost to follow up cases in rural districts in Zambia.

  6. Methods • A Prospective Cohort Study • Newly diagnosed HIV clients from April 2012 to March 2013 in 8 health facilities in Kazungula and Kalomo has been enrolled. • The data have been collected through clients’ records and interviews • Assessed at June 2013 • The retention rates were estimated by Kaplan-Meier method

  7. Result Table 1. Baseline characteristics of enrolled cases

  8. Table 1. Baseline characteristics of enrolled cases (cont’d)

  9. Result Pre-ART 240 clients (36.7%) Figure 1. Continuum of HIV care in enrolled cases ART 414 clients (63.3%) No access to HIV care 168 / 822 clients (20.4%) LTFU at 12 months 139 / 654 clients (21.3%)

  10. Result 12 months retention ART 75.4% Pre-ART 75.9% Figure 2. Pre-ART and ART retention rate (Kaplan-Meier estimates)

  11. Result Lost to Follow up at 12 months n = 139 Have phone number 53 / 139 ( 38.1%) No phone number 86 / 139 ( 61.9%) Figure 3. The LTFU cases traced by phone

  12. Result Lost to Follow up at 12 months n = 139 Have phone number 53 / 139 ( 38.1%) No phone number 86 / 139 ( 61.9%) Invalid/Wrong number 22 / 53 (41.5%) Reachable to Clients 17 / 53 (32.1%) Not Reachable 14 / 53 (26.4%) Figure 3. The LTFU cases traced by phone

  13. Result Lost to Follow up at 12 months n = 139 Have phone number 53 / 139 ( 38.1%) No phone number 86 / 139 ( 61.9%) Not Reachable 14 / 53 (26.4%) Invalid/Wrong number 22 / 53 (41.5%) Reachable to Clients 17 / 53 (32.1%) Returned to the original facility 3 / 17 (17.6%) Self transfer out to other facility 4 / 17 (23.5%) Not returned on the care 10 /17 (58.9%) Figure 3. The LTFU cases traced by phone

  14. Result 122 / 139 (87.8%) need physical follow-up Lost to Follow up at 12 months n = 139 Have phone number 53 / 139 ( 38.1%) No phone number 86 / 139 ( 61.9%) Invalid/Wrong number 22 / 53 (41.5%) Reachable to Clients 17 / 53 (32.1%) Not Reachable 14 / 53 (26.4%) Returned to the original facility 3 / 17 (17.6%) Self transfer out to other facility 4 / 17 (23.5%) Not returned on the care 10 /17 (58.9%) Figure 3. The LTFU cases traced by phone

  15. Discussions(1) • The reasons for Many LTFU cases were maybe; - long distances to access ART services. - bad road condition in the rainy season. - not enough attention by staff and supporters. - still have some stigma among HIV clients. - many seasonal migrants (fishermen) in some sites. • The linkage between diagnosis and care should be strengthened. • There is need to conduct adequate counseling soon after HIV diagnosis

  16. Discussions (2) • Tracing LTFU case by phone is not feasible in rural area of Zambia because, - most clients do not have Mobile phones - some clients give wrong phone numbers - poor accessibility of phone networks in rural area • Adherence counseling at every visit and physical tracing should be strengthened. • Need to consider how to motivate treatment supporters.

  17. Conclusions • Despite having successful scaled up HIV services to many rural health facilities, we still have a big number of LTFU cases. • There is urgent need to strengthen active tracing of LTFU cases.

  18. Acknowledgement • Our patients • Treatment supporters • District Community Medical Offices • JICA-SHIMA project • NCGM • MCDMCH- Zambia • MOH- Zambia

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