Competencies and sensitivity of the ORWs were enhanced through training and formal and informal feedbacks. The tracking mechanism has undergone and adapted to various changes such as - reduction of CCCs, closure of programmes, change in the formats, and increase in ART centres, Link ART centres, and changes in tracking partners. Prevention: Prevention is the critical component to address the LFU issue. • • •
Besides tracking, Balasahyoga also focused on prevention of LFUs in the ART centre through initiation of MIS tracking, daily due list generation and phone follow up Balasahyoga staff has ensured that the ART clients avail transport facility provided by government. Institutionalized LFU tracking through regular ART-CCC coordination meetings across all ART centres, regular generation and sharing of LFU line list with tracking partners and initiating appropriate actions on the feedback received from the partners.
Distinctions learnt Many distinctions are in order. One should not assume that ART centre visit adherence is same as treatment adherence. It is learnt during the field visits to BSY households that some clients do religiously come to the ART centre, but don’t even open the bottles. They carry the same old bottle as well. Some clients do throw away the tablets as well to show that they are adhering to the treatment. Visit adherence is not equal to treatment adherence and thus should not be construed as same. Treatment access, Treatment adherence, Treatment failure, and LTFU should be treated differently because they have different root causes and require different interventions. The ART centre should make conscious efforts to identify the other possible family members who might have infected thus need ART treatment. The client is individual, but the ART centre should consider the client as a part of the family and thus gently force themselves to make them part of the services through counseling, testing and treatment.
Challenges and Issues in tracking LFU The cumulative LFU reporting at ART centres is often incorrect because: • The denominator comprises of all the old LFUs and unless the client is confirmed dead or resume treatment, they are reported as LFUs. • LFUs from other districts, states, clients are registered as new cases