BACKGROUND: By 2020, 89% of the estimated 55,000 people living with HIV (PLHIV) in Papua New Guinea (PNG) were on antiretroviral therapy (ART), although the effectiveness of therapy was reduced by interruptions in treatment (IIT) and recycling in care. Attrition was aggravated by COVID-19 related restrictions on travel and HIV service delivery. In September 2021, the USAID HIV Support in PNG project implemented a back-to-care (B2C) surge activity to trace and return clients who had IIT after starting ART in 11 clinics of the National Capital District.
DESCRIPTION: A list of PLHIV who had started ART but discontinued as of September 30, 2020, was generated from facility electronic medical records. In collaboration with ART clinic staff, the project team reviewed client files to verify attendance status. FHI 360, in collaboration with the PNG network for PLHIV (IGAT HOPE), developed clinic-specific follow-up plans. Using geospatial information extracted from electronic records, specific areas were prioritized, and teams assigned to optimize outcomes. Teams were provided with IIT listings and logistics support to follow-up clients and return them B2C. Monitoring of individual performance was used to assess outcomes and implement improvements.
LESSONS LEARNED: Follow-up was attempted over one month for 56% (n=636) of the 1,126 clients confirmed to have IIT. Attempts were successful for 74% (n=473). Of those, 35% (n=164) were reconnected to treatment, 31% (n=146) were identified as silent transfers, 10% (n=47) died, 19% (n=90) were tracked but did not return to care, and 5% (n=26) opted-out of ART. A total of 26% (n=163) lacked clear physical addresses in clinic records, changed their phone numbers, or used false names, which made them impossible to follow-up. Given the success of this initial intervention and the number of clients still requiring follow-up, enhancing B2C by extending the implementation period and/or increasing the number of follow-up teams was needed.
CONCLUSIONS: Though only 1-month, this health-facility-owned, peer-driven B2C surge activity was effective in returning disengaged PLHIV to treatment. Regular B2C surges can be used by programs to complement routine follow-up and active case management. Qualitative analysis exploring reasons for treatment cessation can be used to complement surges and improve understanding of barriers.

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