Paper tracking is considered the 'minimal sufficient package', ‘lite-touch approach’ or ‘basic option’ for tracking LTFU patients in resource-limited settings because it is cost-effective. This option entails establishing a sample of HIV “lost” patients to be tracked, reviewing their file/charts in the health facilities, completing a simple questionnaire to capture vital and HIV in-care status and conclude this process by analysis of the findings.

However, if an organisation or HIV program has sufficient financial and human resources, then the tracking of LTFU patients can progress from Paper to Phone and from Phone to Field Tracking as was implemented in the BetterInfo study.

Paper Tracking is the first step in which files/charts of LTFU patients are reviewed from the registry room of the health facility. The aim is to confirm if the patient should be tracked; to find the patient’s identity and contact details; and to document the tracking process as well as information needed for tracking. See Annex 7.1: Paper Tracking SOP. In BetterInfo the average paper tracking time per patient found was 54 minutes. See Annex 7.4: Time Tracking SOP.

Phone Tracking is the second step which involves contacting the patient or patients' next-of-kin using telephonic communication. BetterInfo used both Airtel and MTN mobile network providers to contact patients. This is because some study sites only had one of the two network providers while other sites had both networks. The aim of phone tracking is to obtain as much information as possible including obtaining any updated patient and/or treatment supporter/buddy contact information (phone numbers, geographic information); determine the patient’s outcomes (alive or dead, in-care or out-of-care and reasons for out-of-care or transfer); and to document what has been learnt through the tracking process. See Annex 7.2: Phone Tracking SOP. In BetterInfo the average paper and phone tracking time per patient found was 60.5 minutes. See Annex 7.4: Time Tracking SOP.

Field Tracking is the third and final step which involves the tracker going into the community (by walking, bicycle, motor bike, and/or public transport) to try to locate the “lost” patient in person. The aim is to obtain any updated patient and/or treatment supporter/buddy contact information (phone numbers, geographic information); determine the patient’s outcomes (alive or dead, in-care or out-of-care and reasons for out-of-care or transfer); administer questionnaires; and if applicable, obtain biological specimens. See Annex 7.3: Field Tracking SOP. In BetterInfo the average paper, phone and field tracking time per patient found was 300.5 minutes. See Annex 7.4: Time Tracking SOP