In 2006, The Lighthouse Trust launched a patient tracing intervention designed to improve long-term retention in ART care by reducing lost to follow-up (LTFU) ( called Back-To-Care program). The B2C team, using the electronic medical record system, promptly generates a list of ART patients who miss a scheduled ART clinic appointment by 3 or more weeks. Five trained extension workers are responsible full-time for verifying the status of patients on the list to rule out data errors and for tracing patients who miss scheduled appointments by phone, short message service (SMS), home visit. Motorbikes are used for home visit tracing. Patients who are identified as LTFU are contacted by the B2C staff to ascertain true ART outcome status. Status was recorded as either dead, transfer to other ART facility, alive and on ART (uninterrupted therapy or treatment gaps), stopped ART (stopped or never started ART), tracing rejected, refused comment and LTFU. Patients who are found alive and not transferred to other ART facilities are asked to return to the clinic and a clinic appointment is made. Tow further attempts are made for patients who do not realize these appointments before they are classified as “LTFU”
Our previous evaluation showed that the B2C program not only results in a marked increase in ART patients who return to the clinic for ART refills (especially in cases of treatment failure) but it also helps identification of reasons for missing ART clinic appointments among ART patients and how better to assist them. Approximately 74% of the patients who promised to return after being traced, returned to the clinic.
In recent years, the B2C teams has also been involved on tracing ART patients with high viral load and newly identified HIV-infected infants to facilitate patient management.