223058 Assessing the Extent and Reasons for Loss to Follow-Up in a Pediatric HIV Clinic in Northern Ethiopia

Monday, November 8, 2010

Anna Talman, MPH(c) , Department of Global Health, University of Washington, Seattle, WA
Happyson Musvosvi, MD, MPH , HIV/AIDS Initiative, William J. Clinton Foundation, Addis Ababa, Ethiopia
Sarah Pasternak, MPH , HIV/AIDS Initiative, William J. Clinton Foundation, Addis Ababa, Ethiopia
Yigeremu Abebe, MD , HIV/AIDS Initiative, William J. Clinton Foundation, Addis Ababa, Ethiopia
Selamawit Getamasay Mola, RN , Pediatric Initiative, William J. Clinton Foundation, Addis Ababa, 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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Program planning

Learning Objectives:
* Participants will be able to describe the pattern of loss to follow-up in a pediatric HIV-patient population in Ethiopia and to differentiate the reasons for pediatric loss to follow-up from adult loss to follow-up. * Participants will be able to discuss the implications of high rates of loss to follow-up and the importance of tailoring program design and management to address patient retention.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I helped to manage this intervention as my practicum for my MPH degree.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.