TY - JOUR
T1 - Identifying and reengaging patients lost to follow-up in rural Africa
T2 - The “horizontal” hospital-based approach in Uganda
AU - Alizadeh, Faraz
AU - Mfitumuhoza, Gideon
AU - Stephens, Joseph
AU - Habimaana, Christopher
AU - Myles, Kwiringira
AU - Baganizi, Michael
AU - Paccione, Gerald
N1 - Publisher Copyright:
© Alizadeh et al.
PY - 2019/3
Y1 - 2019/3
N2 - 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.
AB - 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.
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U2 - 10.9745/GHSP-D-18-00394
DO - 10.9745/GHSP-D-18-00394
M3 - Article
C2 - 30926739
AN - SCOPUS:85063738162
SN - 2169-575X
VL - 7
SP - 103
EP - 115
JO - Global Health Science and Practice
JF - Global Health Science and Practice
IS - 1
ER -