Marguerite Susich, Patrick Ulysse, Alain Casseus, Annie Michaelis and Joia Mukherjee
Objective: Initiatives aimed at improving patient retention in HIV care in Haiti have focused on a wide range of tactics for identifying individuals who are lost to follow-up yet the patient perspective is often missing from efforts to understand and address the root causes of lost to follow-up.
Methods: As part of a routine quality control audit of the HIV program, structured interviews were conducted with 100 patients who had returned to care after previously being lost to follow-up at three rural health centers in the Lower Artibonite region of Haiti supported by the non-governmental organization Zanmi Lasante. These interviews uncovered factors that contributed to patients’ previous lack of follow up and elucidated factors that influenced their return to care. The interviews sought to capture the patients’ preferred communication methods and their suggestions for improvements in HIV care at the health facility.
Results: As part of a quality of care audit, 100 patients were interviewed in November and December 2014, and their reasons for loss to follow-up were identified. The common factors noted were socio-economic barriers to remaining in care, challenges affecting case management at both provider and the facility level, and patient perceptions of good health. 74% of the respondents identified increased communication by health care professionals through telephone calls and home visits as the reason they chose to return to care. Respondents suggested increase in economic and transportation support, improved communication between providers and patients, improved clinic experience, and increased medication management as factors that would decrease lost to follow up in the future.
Conclusion: Reasons for loss to follow-up in this rural Haitian population reflect similar social and structural barriers common to lost to follow-up populations globally, however patients participating in these interviews reported unique barriers in communication as inhibiting factors to remaining in care. By utilizing this feedback from end users of the health system as an essential component in the design and implementation of service improvements, health systems can more effectively diminish loss to follow-up.
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