Outcomes and associated risk factors of patients traced after being lost to follow-up from antiretroviral treatment in Lilongwe, Malawi

Patients who were more than 2 weeks late according to their last ART supply and who provided a phone number or address in Lilongwe were eligible for tracing. Their outcomes were updated and risk factors for successful tracing and death were examined.Of 1800 patients LTFU with consent for tracing, 724 (40%) were eligible and tracing was successful in 534 (74%): 285 (53%) were found to be alive and on ART; 32 (6%) had stopped ART; and 217 (41%) had died. Having a phone contact doubled tracing success (adjusted odds ratio, aOR = 2.1, 95% CI 1.4-3.0) and odds of identifying deaths [aOR = 1.8 (1.2-2.7)] in patients successfully traced. Mortality was higher when ART was fee-based at initiation (aOR = 2.3, 95% CI 1.1-4.7) and declined with follow-up time on ART. Limiting the analysis to patients living in Lilongwe did not change the main findings.Ascertainment of contact information is a prerequisite for tracing, which can reveal outcomes of a large proportion of patients LTFU. Having a phone contact number is critical for successful tracing, but further research should focus on understanding whether phone tracing is associated with any differential reporting of mortality or LTFU.The large proportion of patients lost to follow-up (LTFU) is one of the major challenges to the ongoing success of antiretroviral treatment (ART) programs in sub-Saharan Africa [1-3]. Data from a network of ART programs in resource-limited settings showed that on average 21% of patients had been lost from programs in the first six months after starting ART [3]. A systematic review found that about 40% of patients in sub-Saharan Africa were lost at two years, with large variation in retention rates between programs [2]. A further systematic review and meta analysis of studies, which determined the vital status of patients LTFU after starting ART, found that mortality among successfully traced patients in African ART program ranges from 12% to 87%, with a combined mortality of 46% [4].A better under