Challenges with tracing patients on antiretroviral therapy who are late for clinic appointments in rural South Africa and recommendations for future practice

Figures & data

Box 1. Description of the organisations that assist with tracing in Agincourt

Right-to-care: Founded in 2001 Non-profit organisation who provide prevention, care and treatment for HIV and associated diseased (tuberculosis, cervical cancer, and other STIs) Work with government and communities to find solutions to build and strengthen public health care In Agincourt, this constitutes assistance with tracing usually through assistance with telephone tracing Home-Based cares: Started in the late 1980s in rural villages of the Limpopo region Introduced as a way of improving healthcare practices to promote health through population sensitisation around aspects including child care, nutrition, and personal hygiene In recent years they have become more strucutred and are at the forefront of healthcare service delivery including delivery of treatment, care and support for people living with HIV In Agincourt they assist with healthcare promotion and physical tracing of people living with HIV who are late for their scheduled clinic visits

Table 1. Selected characteristics of the eight clinics that serve the study area

Clinic	Type	Number of HDSS residents 18+ years that initiated ART between 2014–2017	Right to care presence	Personnel consulted	Number of days of observations
Agincourt community health centre	Public	975	Yes	Ward Based Outreach Team (WBOT) nurse, Facility manager (Sister-in-charge), Home Based Carers, Right-to-Care linkage officer, community health worker	6
Belfast clinic	Public	582	Yes (started July 2017)	Data typist, Right-to-Care linkage officer, Home Based Carers	4
Bhubezi community health centre	Public (originally private, merged with Lillydale clinic a public facility, in 2016)	689	Yes	Home Based Carers, 2 Data typists, Right-to-Care linkage officer, Right-to-Care supervisor	5
Cunningmore clinic	Public	300	No (Linkage officer resigned in 2016)	Data typist, 2 staff nurses, Home Based Carers, Right-to-Care supervisor	3
Justicia clinic	Public	423	No	Data typist, Home Based Carers, staff nurse	4
Kildare clinic	Public	586	Yes	Facility manager, data typist, Right-to-Care linkage officer, Home Based Carers	5
Thulamahashe community health centre	Public	133	Attached (same linkage officer works in Belfast and Bhubezi)	Data typist, Right-to-Care linkage officer	3
Xanthia clinic	Public	235	Attached (same linkage officer works in Agincourt)	Data typist, Home Based Carers, Right-to-Care linkage officer	3

Figure 1. Tracing steps and personnel in charge of each step

Figure 2. Performance on specific indicators from the tracing cascade for eight health facilities