Abstract

WEAE0202 - Oral Abstract Session

A laboratory-based approach to reduce loss to follow-up of HIV-positive clients

Presented by Chioma Onyinye Nwuba (Nigeria).

C.O. Nwuba¹, T. Dagunduro¹, C. Umenyi¹, B. Peters², F. Afolayan³, O. Abolarin<sup>4

1</sup>Management Sciences for Health, Prevention Organizational Systems, AIDS, Care and Treatment, Ilorin, Nigeria, ²Children Specialist Hospital, Laboratory Unit, Ilorin, Nigeria, ³General Hospital, Laboratory Unit, Omuaran, Nigeria, ⁴Specialist Hospital, Laboratory Unit, Offa, Nigeria

Background: In Nigeria, the progressive loss of patients at every stage in antiretroviral therapy (ART) programs especially at the point of uptake of CD4 monitoring poses a threat to the achievement of treatment targets. Long waiting time coupled with the burden of traveling long distances for blood draw and receipt of CD4 results has led to attrition in the number of clients who test positive to HIV versus the number who eventually commence ART.
Methods: In order to increase uptake of CD4 monitoring and reduce loss to follow up (LTFU) at three USAID/MSH supported HIV care and treatment clinics, the following interventions were instituted .
1. Task shifting to data clerks to fill laboratory request forms for CD4 monitoring instead of clinicians who complain of heavy workload.
2. Strengthened escort services from the point of enrollment to the laboratory to ensure that clients access laboratory investigations on the same day.
3. Task shifting to laboratory technicians on the use of automated CD4 equipments after consistent onsite training and supervision.
4. Established point of care sample collection for CD4 estimation.
5. We commenced daily CD4 investigations (Monday to Friday) ensuring that clients attending clinics from long distances access CD4 monitoring on any day of the week.
6. Commenced 24 hours turnaround time for release of CD4 result to ensure rapid initiation of eligible clients on ART.
Results: After 12 months, number of clients accessing CD4 investigations increased from 53.8% to 93.3% while number of clients LTFU reduced from 58.7% to 10.7%. Turnaround time for CD4 results decreased from 7 days to 24 hours. Average client waiting time reduced from 4 hours to 1hour 30mins.
Conclusions: Strengthening laboratory systems helps increase uptake of CD4 investigations, shorten client waiting time and ultimately reduces LTFU especially among clients attending clinics from hard to reach communities with difficult terrains.