Identifying and reengaging patients lost to follow-up in rural Africa

The “horizontal” hospital-based approach in Uganda

Faraz Alizadeh, Gideon Mfitumuhoza, Joseph Stephens, Christopher Habimaana, Kwiringira Myles, Michael Baganizi, Gerald A. Paccione, Jr.

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Among the many challenges facing health systems grappling with the explosive growth of chronic disease in Africa are continuity of care, particularly in poor, rural areas. We report the strategy, field experience, and results of an ongoing 6-year follow-up program operating in a rural district hospital in Kisoro, Uganda, that attempts to locate and reengage patients lost to follow-up (LTFU) from communities that are largely without phones, addresses, or paved roads. The program works with diverse hospital clinics, including chronic diseases, HIV, tuberculosis (TB), nutrition, and women’s health, to identify patients who have not returned to care, employing a modest staff who spend about 20 days monthly making outreach visits by motorcycle in search of approximately 130 patients. We describe the organization of this unique “horizontal” program and report on follow-up outcomes between November 2015 to October 2016. Between 30% and 60% of patients were found to have lapses in care. The follow-up program was able to locate 64% of patients, with a reengagement rate of 54% to 92% (average, 69%) depending on the clinic. The program costs approximately US$5 per patient LTFU but about US$40 per patient maintained in care. The hospital-based follow-up program that cuts across diverse clinics and wards was novel and feasible in this rural sub-Saharan African setting.

Original languageEnglish (US)
Pages (from-to)103-115
Number of pages13
JournalGlobal Health Science and Practice
Volume7
Issue number1
DOIs
StatePublished - Mar 1 2019

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Uganda
Lost to Follow-Up
Chronic Disease
Motorcycles
Rural Hospitals
Continuity of Patient Care
District Hospitals
Women's Health
Tuberculosis
HIV
Organizations
Costs and Cost Analysis
Health
Growth

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Identifying and reengaging patients lost to follow-up in rural Africa : The “horizontal” hospital-based approach in Uganda. / Alizadeh, Faraz; Mfitumuhoza, Gideon; Stephens, Joseph; Habimaana, Christopher; Myles, Kwiringira; Baganizi, Michael; Paccione, Jr., Gerald A.

In: Global Health Science and Practice, Vol. 7, No. 1, 01.03.2019, p. 103-115.

Research output: Contribution to journalArticle

Alizadeh, Faraz ; Mfitumuhoza, Gideon ; Stephens, Joseph ; Habimaana, Christopher ; Myles, Kwiringira ; Baganizi, Michael ; Paccione, Jr., Gerald A. / Identifying and reengaging patients lost to follow-up in rural Africa : The “horizontal” hospital-based approach in Uganda. In: Global Health Science and Practice. 2019 ; Vol. 7, No. 1. pp. 103-115.
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