Tracing people living with HIV who are lost to follow-up at ART programs in Southern Africa: A sampling-based cohort study in six countries.

Ballif, Marie; Christ, Benedikt; Anderegg, Nanina; Chammartin, Frédérique; Muhairwe, Josephine; Jefferys, Laura; Hector, Jonas; van Dijk, Janneke; Vinikoor, Michael J; van Lettow, Monique; Chimbetete, Cleophas; Phiri, Sam J; Onoya, Dorina; Fox, Matthew P; Egger, Matthias (2021). Tracing people living with HIV who are lost to follow-up at ART programs in Southern Africa: A sampling-based cohort study in six countries. (In Press). Clinical infectious diseases The University of Chicago Press 10.1093/cid/ciab428

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Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of people living with HIV (PLHIV) lost to follow-up (LTFU) 2014-2017 at ART programs in Southern Africa.


We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were LTFU in eight ART programs in Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe, 2017-2019. We ascertained vital status and identified predictors of mortality using logistic regression, adjusted for sex, age, time on ART, time since LTFU, travel time, and urban or rural setting.


Among 3,256 PLHIV, 385 (12%) were wrongly categorized as LTFU and 577 (17%) had missing contact details. We traced 2,294 PLHIV (71%) by phone calls, home visits or both: 768 (34% of 2,294) were alive and in care, including 385 (17%) silent transfers to another clinic; 528 (23%) were alive without care or unknown care; 252 (11%) had died. Overall, the status of 1,323 (41% of 3,256) PLHIV remained unknown. Mortality was higher in men than women, higher in children than in young people or adults, higher in PLHIV who had been on ART <1 year or lost >1 year, living further from the clinic or in rural areas. Results were heterogeneous across sites.


Our study highlights the urgent need for better medical record systems at HIV clinics and rapid tracing of PLHIV who are LTFU.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Ballif, Marie; Christ, Martin Benedikt; Anderegg, Nanina Tamar; Chammartin, Frédérique Sophie and Egger, Matthias


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




The University of Chicago Press




Doris Kopp Heim

Date Deposited:

19 May 2021 19:36

Last Modified:

19 May 2021 21:00

Publisher DOI:


PubMed ID:


Additional Information:

Ballif and Christ contributed equally to this work.

Uncontrolled Keywords:

HIV Southern Africa Tracing lost to follow-up vital status




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