HTS

Loss to Follow-Up Tool: Tracking and Tracing HIV Patients

WHAT IS THE PROBLEM?

Loss at each step of the HIV diagnostic and treatment cascade has been well documented. Many newly-identified people living with HIV (PLHIV) fail to link to or enroll in care and initiate treatment, and those on antiretroviral treatment (ART) often miss appointments and fail to return to care/treatment. Addressing poor linkage and retention is critical for achieving HIV/AIDS epidemic control. Successful tracking and tracing of PLHIV who have failed to initiate treatment or failed to return to care/treatment will allow targeted interventions to help return those patients back to treatment, document their treatment in another setting, or document their death or loss to follow up (LTFU).

WHAT IS THE TOOL?

Identifying and locating PLHIV who fail to link to care and initiate ART or who fail to be retained in care/on treatment are important interventions to ensure all PLHIV get on and remain on ART. This tool outlines procedures for tracking and tracing PLHIV who have failed to link to treatment or those who have missed appointments/are LTFU. Procedures for identifying, following non-linkers and those not in care/on treatment through phone and home contacts, and documenting outcomes are outlined. Individual level follow-up allows for targeted support to PLHIV needing to (re-)enter care and treatment. In addition, documentation of individual outcomes is necessary to obtain accurate numbers of patients who are actually not in care and on treatment and the outcomes of those who are LTFU including silent transfers to other clinics, death, those who are unable to be located, not traced, or returned to care/clinic. These outcomes are required for the TX_ML MER indicator. Best practice procedures for phone and home contacts are provided, as well as sample tools from partners for recording tracking and tracing activities.

Tracking and Tracing Standard Operating Procedure (SOP)

Example Tracking Record from Zimbabwe

Tracking and Tracing Form (Sample B)

Example SMS Message (Sample C)

Index and Partner Notification Testing Toolkit

What is the problem?

Index testing and partner notification is a core intervention used to efficiently and effectively identify HIV-positive individuals. However, tools that helped ensure index testing programs were implemented with appropriate quality, scale, and fidelity were not readily available.

What is the tool?

The following Job Aids (ppt) lists 6 recommended steps to follow when implementing the Index and Partner Notification Testing Toolkit. These are:

Step 1: Use  Talking Points & Scripts for Index Testing Services (doc) to introduce partner/family testing to the index client and complete the Index Client Information Form (page 1 of Tools for Documenting & Monitoring Partner Notification Services (doc)).

Step 2: Use the Partner/Child Elicitation Form (page 2 of Tools for Documenting & Monitoring Partner Notification Services (doc)) to record partner(s)' names and contact information.

Step 3: Use the Partner Information Form (pages 3-4 of Tools for Documenting & Monitoring Partner Notification Services (doc)) to document results of IPV screening and preferred partner notification method and/or child testing method.

Step 4: Determine preferred method of partner notification: client referral; contact referral; provider referral; or dual referral. Additional tips and scripts for the referral processes can be found in Patient Information & Handouts (doc).

Step 5: Contact all named partners using the preferred approach.

Step 6: Record partner notification outcomes on the Outcome of Testing Forms (pages 5-6 of Tools for Documenting & Monitoring Partner Notification Services (doc)).

Step 7: Provide appropriate services for children and seroconcordant/discordant partners based on HIV status.

All forms and documents listed above, along with other useful handouts, can be found in the Index Testing Handouts (doc).

Additional information regarding this toolkit and helpful case studies can be found in Partner & Family-Based Index Case Testing SOP Slides (ppt) and Case Studies for Index Testing (doc). Also, the following spreadsheets can be used when implementing Index and Partner Notification Testing: