Promoting client retention during PMTCT and follow up care :Lessons learned through

active client follow-up in Kenya and South Africa

Monica Nolan, Nicole Fulton, Morgan Goheen, Milker Simba and Mitch Besser

Description

m2m piloted two ACFU strategies at selected clinic sites in Kenya and South Africa

Kenya: pilot conducted at 10 sites in Nairobi– Defaulting clients identified from m2m client records– Targeted events were multiple – ACFU = text message and up to six phone calls– Reasons for missing visits and outcomes tracked

Kenya Pilot

Reason for ACFU

Missed Event

• 2nd AN Visit• CD4 Test

• CD4 Result

• Mom HAART

• 2nd PN Visit

• Baby Cotrim.

• HIV 6wk Test

• HIV 6wk Result

• Baby HAARTBusy or forgot37%

Travel14%_x001c_Lack of funds

or incentives 7%

Stigma, denial or non-disclosure

16%

Lack of in-formation

7%

Sickness3%

Poor quality services

4% Other12%

Reasons for non attendancen = 251

Lessons Learned Kenya, n = 465 ACFU Client Outcomes

travel or relocated14%

attended clinic46%

not reached 21%refused call

3%

miscarriage, mother or infant death

1%

ongoing 15%

Description South Africa: pilot conducted at 10 sites in East London

– Quasi experimental : 5 ACFU and 5 non-ACFU sites – All pregnant clients enrolled from 32 weeks – Targeted event was infant testing at 6 weeks – Defaulting clients identified from m2m client records– ACFU = up to three phone calls followed by home visit

– See m2m poster THPE0286 for details.

Non-ACFU Sites ACFU Sites 0

10

20

30

40

50

60

70

80

90

78%

N= 418

p < 0.001

Infant HIV Testing Uptake at 16 Weeks Post Delivery

204

214

56%

Conclusions

Telephone ACFU appears feasible, acceptable and effective in influencing client retention and thus contribute to improved PMTCT and other outcomes

m2m is working to integrate active client follow-up as part of m2m services