Assessing the Extent and Reasons for Loss to Follow-Up in a Pediatric HIV Clinic in Northern Ethiopia

Loss to follow-up (LTFU) is a critical concern for HIV treatment programs. Although previous studies have found rates of LTFU as high as 25% in adult populations in Africa, minimal data are available regarding LTFU in Ethiopia, and data regarding pediatric cohorts are especially scarce. The objective of this project was to assess LTFU among pediatric patients at a referral hospital in Ethiopia. The project sought to identify and track all patients LTFU, to ascertain the reasons for default, and to encourage families to re-enroll in care. Clinicians performed a chart review of all pediatric HIV patients to identify LTFU. Community health workers then tracked patients' families, ascertained the reasons for default through a questionnaire, provided health education, and encouraged re-enrollment. Of 842 patients enrolled in treatment and care, 401 (47.6%) patients were identified as being LTFU by our definitions. 329 children were tracked, and 128 (39.8%) of these families were located. Families' reasons for defaulting were multiple and varied widely. Overall, death of the child (18.7%), and the residence relocation (18.0%) were the most common reasons reported. Administrative errors such as duplicate charts and incorrect addresses accounted for 20.9% of LTFU. High rates of LTFU were found in this pediatric population, higher than those reported in adult populations. Further study of LTFU in pediatrics, increased attention to retention as a programmatic area of focus, and interventions to ensure patient follow-up are needed. Specific interventions might include increased health education, transportation support, improved documentation, and collaboration with community-based organizations.