Mobility and Clinic Switching among HIV Patients Considered Lost to Follow-up in North-Eastern South Africa

David Etoori, London School of Hygiene and Tropical Medicine
Alison Wringe, London School of Hygiene and Tropical Medicine (LSHTM)
Brian Rice, London School of Hygiene and Tropical Medicine
Jenny Renju, Kilimanjaro Christian Medical University College
Georges Reniers, London School of Hygiene and Tropical Medicine (LSHTM)

We assessed the extent of undocumented clinic transfer among HIV patients lost to follow-up (LTFU) by antiretroviral therapy (ART) initiation reason in a rural South African setting. We conducted a comprehensive record review for patients categorised as LTFU in 8 clinics within the Agincourt Health and Demographic Surveillance System (AHDSS) in rural north-eastern South Africa to ascertain their “true” outcomes. This involved reviewing clinic and routine tracing records, comparing against demographic surveillance data, to ascertain migration or mortality events, and conducting supplementary tracing for patients for whom an outcome could not be ascertained. To assess patterns of movement between clinics, Google maps was used to ascertain decimal degree coordinates for each facility where patients were receiving treatment (initially and in the event of a change). We found evidence of continued care characterised by high rates of undocumented transfers after LTFU and identified local and nationwide clinic mobility among HIV patients.