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Concept Mapping (CM), a mix-method participatory approach, was used to explore why patients on ART are lost to follow-up (LTFU) by identifying: 1) factors that influence patient losses to follow-up and 2) barriers to effective and efficient tracing in Zomba, Malawi.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>CM sessions (brainstorming, sorting and rating, interpretation) were conducted in urban and rural settings in Zomba, Malawi. Participants included ART patients, ART providers, Health Surveillance Assistants, and health managers from the Zomba District Health Office. In brainstorming, participants generated statements in response to \u201cA specific reason why an individual on ART becomes lost to follow-up is\u2026\u201d Participants then sorted and rated the consolidated list of brainstormed items. Analysis included inductive qualitative methods for grouping of data and quantitative cluster identification to produce visual maps which were then interpreted by participants.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In total, 90 individuals brainstormed 371 statements, 64 consolidated statements were sorted (participant n\u2009=\u200946), and rated on importance and feasibility (participant n\u2009=\u200969). A nine-cluster concept map was generated and included both patient- and healthcare-related clusters such as: <jats:italic>Stigma and Fears, Beliefs, Acceptance and Knowledge of ART, Access to ART, Poor Documentation, Social and Financial Support Issues, Health Worker Attitudes, Resources Needed for Effective Tracing,<\/jats:italic> and <jats:italic>Health Worker Issues Related to Tracing<\/jats:italic>. Strategies to respond to the clusters were generated in Interpretation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Multiple patient- and healthcare focused factors influence why patients become LTFU. Findings have implications particularly for programs with limited resources struggling with the retention of ART patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1472-6963-13-210","type":"journal-article","created":{"date-parts":[[2013,6,11]],"date-time":"2013-06-11T06:14:20Z","timestamp":1370931260000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Using concept mapping to explore why patients become lost to follow up from an antiretroviral therapy program in the Zomba District of Malawi"],"prefix":"10.1186","volume":"13","author":[{"given":"Beth","family":"Rachlis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"van Lettow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adamson S","family":"Muula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Medson","family":"Semba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald C","family":"Cole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2013,6,11]]},"reference":[{"key":"2672_CR1","unstructured":"Joint United Nations Programme on HIV\/AIDS: Report on the Global AIDS Pandemic. http:\/\/www.unaids.org\/globalreport\/global_report.htm."},{"key":"2672_CR2","unstructured":"Joint United Nations Programme on HIV\/AIDS: Report on the the Global AIDS Pandemic. http:\/\/www.unaids.org\/en\/media\/unaids\/contentassets\/dataimport\/pub\/report\/2009\/jc1700_epi_update_2009_en.pdf."},{"key":"2672_CR3","volume-title":"Malawi Demographic and Health Survey","author":"MNS Office","year":"2010","unstructured":"Office MNS: Malawi Demographic and Health Survey. 2010, Zomba, Malawi: Government of Malawi"},{"key":"2672_CR4","volume-title":"Children and AIDS. 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