Accounting for Patient Losses Through Retention Audit and Root Cause Analysis

Overview

Despite strengthening program implementation and scaling up interventions that are aimed at optimizing care and treatment, the HIV program struggled with retention of patients and with a high number of patients’ falling off the care and treatment cascade. The approximate HIV/AIDS program retention rate is 88%, and between October 2018 and June 2020, the Lesotho program recorded 33,398 patient losses in 10 U.S. President’s Emergency Plan for AIDS Relief–supported districts. The patients lost between October 2018 and June 2020 couldn’t be accounted for; therefore, an audit was paramount to understand the attrition.

The audit served to better explain the loss of 33,398 patients on ART and to develop interventions to prevent further client attrition and grow the treatment program. The objectives of the audit were the following:

1. Accurately identify the number of patients no longer on ART
2. Describe the sociodemographic and clinical characteristics of 33,398 ART patients identified as no longer being on ART
3. Identify patient, provider, or systems-related factors associated with the loss of patients on ART

The evaluation questions aimed to provide an understanding of whether all patients reported as losses from the program are no longer on ART and who comprises the patients exiting the treatment cohort in the past 21 months. Through this audit, EGPAF–Lesotho highlights strategies to both analyze patient losses and improve retention.

Download the issue brief here.