Patient tracking and retention with Malawi's electronic medical records system in antiretroviral treatment clinics.

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.