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Those LFU clients who have resumed treatment were considered as a new patient, and these patents have not removed from the LFU list as there are no clear written guidelines from NACO/APSACS. Many of the LFU clients have not given their real names, correct/complete addresses, and hence it is difficult to track these clients.
In addition to these factors, various other operational challenges also affect On-ART LFU tracking, these are: •
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Lack of sufficient and trained human resources on ground for tracking and followup. As of 31st March 2011, PPTCT outreach, HIV-TB outreach, ACT project (Access to Care and Treatment), Freedom Foundation have been transitioned out. Nurse Practitioners in the PHC also cannot be used. As of today also, in some districts CCCs are also not there. Partners and the ORWs are reduced heavily. Tracking majority of the clients is also a challenge now. CCCs ORWs are also not available mainly due to NACO evaluation report and thus closure of D grade CCCs. Remaining C and B grade CCCs are not that enthusiastically interested to do tracking, as there is a kind of hesitancy. Due to closure of PPTCT project, PPTCT plus ORWs were assigned to track LFU clients.Closure of Community Care Centres whose outreach workers were also assigned LFU tracking functions Transfer out of clients to other ART centres (because of establishment of new ARTCs and Link ART Centres (LACs) within the District. Side effects due to change in ART regimen (recent observation) Making a child resume treatment is difficult as it depends on the care givers constraints and willingness. As a result, LFU child’s treatment resumption percentages are lower than adults.
As of now, realignments and readjustments are happening at the district level. In spite of that, it is a possibility that all new LFU clients in a district cannot be tracked completely in any one month. It is suggested to the ART centre staff to focus on MIS tracking through phones and on field as well so as to prevent the LFUs happening. It is not yielding consistent results due to erratic practice and non availability of phone numbers for many of the MIS cases.
Lessons Learnt: Building the correct and managing expectations is very much important. APSACS at some time during this period expected that BSY-TAPS can take address verification role in the districts where the CCCs are not functioning and BSY need to take proactive role in reducing LFU in three districts – West Godavari, Guntur, and Cuddaph which was done. LFU tracking is energy intensive, time consuming. Most partners naturally fear that it might end up as another huge work. BSY-TAPS felt that they were doing work which they could not report