Challenges with tracing patients on antiretroviraltherapy who are late for clinic appointmentsin rural South Africa and recommendations forfuture practice

David Etoori, Alison Wringe, Jenny Renju, Chodziwadziwa WhitesonKabudula, Francesc Xavier Gomez-Olive & Georges Reniers
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It is common practice for HIV programmes to routinely trace patients who arelate for a scheduled clinic visit to ensure continued care engagement. In South Africa, patientswho are late for a scheduled visit are identified from clinic registers, and called by telephoneup to three times by designated clinic staff, with home visits conducted for those who areunreachable by phone. It is important to understand outcomes among late patients in orderto have accurate mortality data, identify defaulters to attempt to re-engage them into care,and have accurate estimates of patients still in care for planning purposes.


We conducted a study to assess whether tracing of HIV patients in clinics in ruralnorth-eastern South Africa was implemented in line with national policies.


Thirty-three person-day of observations took place during multiple visits to eightfacilities between October 2017 and January 2018 during which clinic tracing processes werecaptured. The facility level implementation processes were compared to the intended tracingprocess and gaps and challenges were identified.


Challenges to implementing effective tracing procedures fell into three broadcategories: i) facility-level barriers, ii) issues relating to data, documentation and record-keeping, and iii) challenges relating to the roles and responsibilities of the different actorsin the tracing cascade.We recommend improving linkages between clinics, improving record-keeping systems,and regular training of community health workers involved in tracing activities. Improvedlinks between clinics would reduce the chance of patients being lost between clinics. Record-keeping systems could be improved through motivating health workers to take ownership oftheir data and training them on the importance of complete data. Finally, training ofcommunity health workers may improve sustained motivation, and improve their ability torespond appropriately to their clientsneeds.

Conclusions: Substantial investment in data infrastructure and healthcare staff training isneeded to improve routine tracing.