A Comparative Analysis of Physical and Mobile Phone Tracing in Clinical Trials in Lilongwe, Malawi

Patient retention is important for proper adherence to clinical trial protocols. Mobile-phone and physical tracing have been implemented at clinics across Malawi to improve retention but tracing effectiveness and attitudes towards tracing have not been sufficiently studied.

In a site-specific phone retention pilot study embedded within the HIV Prevention Trials Network (HPTN) 052 study in Lilongwe, Malawi, all tracing records and additional semi-structured questionnaires from 50 participants were used to obtain attitudes towards tracing efforts and methods. During a retrospective evaluation study at UNC Project, over 20,000 tracing records were analyzed across 49 studies from 2011 to 2019. Success in reaching participants, bringing participants to clinic, and overall tracing costs were analyzed.

In the phone retention pilot study, 47 participants (94%) had positive attitudes towards tracing and 41 (82%) preferred mobile-phone tracing. Of all tracing attempts in the phone retention pilot study, mobile-phone tracing (232/309, 75%) was more successful than physical tracing (147/244, 60%) in reaching patients, and the cost of mobile-phone tracing was less ($4.21 versus $36.63 per tracing attempt). During the retrospective study period, mobile-phone tracing (7808/9522, 82%) was more successful than physical tracing (7742/10606, 73%) in returning patients to the clinic. Mobile-phone tracing saved approximately $32.08 and 92 minutes per tracing attempt.

Mobile-phone tracing is acceptable, feasible, and efficient for clinical trials in Lilongwe, Malawi. Mobile-phone tracing can be used to strengthen patient engagement and improve collection of primary-outcome data for clinical trials.