Effectiveness of the treatment advocate strategy in tracking lost to follow up clients on antiretroviral therapy in sauti yetu project within Temeke municipality

Abstract

ABSTRACT Background: Despite the efforts in expansion of Antiretroviral Therapy (ART) programs in Tanzania, studies have shown that a large numbers of patients are lost to follow up after ART initiation. Therefore, the National Council of People Living with HIV and AIDS has been implementing Sauti Yetu Project in Temeke Municipality since 2016 to address the lost to follow up challenge through Treatment Advocate strategy.

Objective: To assess the effectiveness of the Treatment Advocate strategy in tracking lost to follow up of clients on ART within Sauti Yetu Project in Temeke Municipality.

Materials and Methods: This was a pre and post intervention comparison research design that used both quantitative and qualitative methods of data collection. An interview guide was used to collect data from Treatment Advocates, Care and Treatment Clinic Staff, and Project staff. The questions in the interview guide focused on facilitating factors and barriers in tracking lost to follow up clients on Antiretroviral Therapy. Quantitative data on the number of ART clients lost to follow up pre and post Treatment Advocate intervention was collected from the DHIS2 database, ART registers and project reports. Data were analyzed descriptively to determine the proportion of lost to follow up before and at the end of the Project. The Standard Normal Deviate test was used to compare proportions. For the qualitative data, content analysis was used to explore facilitating factors and barriers in tracking lost to follow ups.

Results: There was significant decrease in proportion of lost to follow up ART clients from 45.1% before the project to 29.6% after the project. The decrease was statistically significant (p<0.001). The facilitating factors found to influence tracking of lost to follow up clients included provision of follow up transport; support of community leadership; provision of technical support; availability of reporting tools; and adequate knowledge among Treatment Advocates in using reporting tools. However, incorrect client’s information recorded; large area coverage; and inadequate number of staff in the Care and Treatment Clinics were mentioned as barriers in tracking lost to follow up.

Conclusion and Recommendations: Treatment Advocate Strategy has been found to be effective in reducing and tracking lost to follow up clients on Antiretroviral Therapy. Considering the effectiveness of the strategy, it is recommended that relevant authorities should scale up this intervention in other areas.