Investigating reasons for clinic absence among HIV-infected patients in Guinea-Bissau - a cohort study

Clinic absence or lost to follow-up is still a big challenge in West Africa, especially in Guinea-Bissau, where retention in care is lower compared to all other low- or middle-income countries. The study aims to explore the reasons for clinic absence among HIV-infected patients in Guinea-Bissau, and to evaluate whether the telephone tracing is associated with patients returning to clinic follow-up. A prospective cohort analysis was conducted. Data were collected through telephone calls in which patients or their contact persons were asked for reasons for non-attendance. A total of 3,668 patients, who had been considered as clinic absent were enrolled in this study; 1,883 (51.3%) on antiretroviral treatment (ART) and 1,785 (48.7%) without ART. The median time between patients last clinic visit to time of calling was 203 days (interquartile range (IQR) 59 - 360 days). 748 (20.4%) patients and additional 364 (9.9%) contact persons were successfully reached. Reasons for clinic absence included traveling 346 (31.1%), death 211 (19.0%), and still having medicine 186 (16.7%). After tracing, 555 (49.9%) of the traced patients returned to the clinic. Nineteen percent of the absent HIV-infected patients had died by the time of calling, underscoring the need to improve patient follow-up in Guinea-Bissau. Telephone calls provide an important tool to address reasons for clinic absence and may lead to patients returning to clinical follow-up. Key words: Clinic Absence, Loss to follow-up, Return, HIV, ART, Telephone, Sub Saharan Africa.