Abstract
Background
Leveraging the widespread availability of the Electronic Medical Records System (EMRS) in Malawi,
the Clinic Missed Appointment (CMA) reporting tool was introduced in April 2021 to support the identification and
reintegration of antiretroviral treatment (ART) clients who miss scheduled clinic appointments, thereby enhancing
patient care and retention. This study examined the impact of the CMA tool on patient retention.
Methods
Using a before–after study design, we conducted trend analysis of nationally program ART data. EMRS data
from October 2020 to June 2023 were analyzed using descriptive statistics to compare periods before and after the
implementation of the CMA tool. Trends in patient retention were assessed, including treatment interruptions, clients
alive on ART, and successful ART restarts. Additionally, these retention indicators were stratified by sex and age-group
to examine differences in the proportions of clients interrupting treatment and returning to treatment.
Results
From October 2020 to June 2023, quarterly cases of ART treatment interruptions decreased by 45%,
while the number of clients alive on treatment increased by 11%. However, the rate of return to care following ART
interruption declined by 70%. The proportion of clients interrupting ART was consistently higher among males (4.2%)
than females (3.4%), while return-to-care rates after interruption did not observably differ significantly by sex. ART
interruption and return-to-care rates also varied by age, with the highest interruption rates observed among children
aged <1 year and the lowest among adults aged >50 years.
Conclusions
Following implementation of the EMRS CMA reporting tool, there was a correlated observed decrease
in ART interruption and improved retention in care. The system’s capacity to quickly and correctly generate follow-up
lists might have optimized time for client tracing. Sex- and Age-sensitive interventions may be important to enhance
treatment adherence and retention.
Keywords
Electronic medical record system, Interruption in treatment, Return to treatment, Missed appointment
