Using a Quality Improvement Approach in the Prevention of Mother-to-Child HIV Transmission Program in Uganda Improves Key Outcomes and Is Sustainable in Demonstration Facilities

2020 ◽  
Vol 83 (5) ◽  
pp. 457-466
Author(s):  
Valerie L. Flax ◽  
Simon Kasasa ◽  
Steven Ssendagire ◽  
Charlotte Lane ◽  
Lynn Atuyambe ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hiv Transmission ◽  
Mother To Child

scholarly journals Applying Quality Improvement Approaches to Reduce Mother-to-Child HIV Transmission and Improve Health and Nutrition Care in Five Countries: Lessons from the Partnership for HIV-Free Survival

2019 ◽  
Vol 18 ◽  
pp. 232595821984745
Author(s):  
Amy F. Stern ◽  
Anisa Ismail ◽  
Esther Karamagi ◽  
Tamara Nsubuga-Nyombi ◽  
Stella Kasindi Mwita ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hiv Transmission ◽  
Retention In Care ◽  
Complex Problem ◽  
World Health ◽  
Free Survival ◽  
Hiv Positive Women ◽  
Vertical Transmission Of Hiv ◽  
Health Organization ◽  
Mother To Child

The World Health Organization guidelines for treating pregnant HIV-positive women and preventing HIV transmission to infants now recommend lifelong antiretroviral treatment for pregnant and breastfeeding women. We applied quality improvement (QI) methods to support governments and facility staff to address service gaps in 5 countries under the Partnership for HIV-Free Survival (PHFS). We used 3 key strategies: break the complex problem of improving HIV-free survival into more easily implementable phases, support a national management team to oversee the project, and support facility-level staff to learn and apply QI methods to reducing mother-to-child transmission. The key results in each country were increases in data completeness and accuracy, increases in retention in care of mother–baby pairs (MBPs), increase in coverage of MBPs with appropriate services, and reduction in vertical transmission of HIV. The PHFS experience offers a model that other multicountry networks can adopt to improve service delivery and quality of care.

scholarly journals Reducing Mother-to-Child Transmission of HIV Using Quality Improvement Approaches

2019 ◽  
Vol 18 ◽  
pp. 232595821985563
Author(s):  
Nigel Livesley ◽  
Astou Coly ◽  
Esther Karamagi ◽  
Tamara Nsubuga-Nyombi ◽  
Stella Kasindi Mwita ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Control Charts ◽  
Hiv Transmission ◽  
Health Workers ◽  
Care Delivery ◽  
Care Quality ◽  
Data Systems ◽  
Statistical Process ◽  
Statistical Process Control Charts ◽  
Mother To Child

Over half of mother-to-child HIV transmission (MTCT) occurs postdelivery. Keeping mother–infant pairs in care remains challenging. Health workers in 3 countries used quality improvement (QI) approaches to improve data systems, mother–infant retention, and facility-based care delivery. The number and proportion of infants with known HIV status at time of discharge from early infant diagnosis programs increased in Tanzania and Uganda. We analyzed data using statistical process control charts. Mother-to-child HIV transmission did not decrease in 15 Kenyan sites, decreased from 12.7% to 3.8% in 28 Tanzanian sites, and decreased from 17.2% to 1.5% in 10 Ugandan sites with baseline data. This improvement is likely due to the combination of option B+, service delivery improvements, and retention through QI approaches. Reaching the global MTCT elimination target and maximizing infant survival will require health systems to support mother–infant pairs to remain in care and support health workers to deliver care. Quality improvement approaches can support these changes.

scholarly journals Comparison of the Effects of Quality Improvement Strategies on Prevention of Mother-to-Child HIV Transmission in a Public and a Private Hospital in Lesotho

2019 ◽  
Vol 18 ◽  
pp. 232595821986930
Author(s):  
Kelello L. M. Lerotholi ◽  
Manone Rantekoa ◽  
Khotso G. Mahlalefa ◽  
Lerato Hlehlisi ◽  
Aurora O. Amoah
Keyword(s):  
Quality Improvement ◽  
Private Hospital ◽  
Hiv Transmission ◽  
Hiv Positive ◽  
Child Transmission ◽  
Routine Service ◽  
Hiv Positive Mothers ◽  
Hiv Exposed ◽  
Mother To Child ◽  
Positive Results

We compared quality improvement (QI) interventions for prevention of mother-to-child transmission in a private hospital and a government hospital (GH). From November 2013 to October 2016, data were extracted retrospectively for HIV-positive mothers and HIV-exposed infants. The overall number of mother–baby pairs (MBPs) was significantly ( P < .001) higher at the GH (mean = 294, standard deviation [SD] = 180) than the private hospital (mean = 72, SD = 27). There was a significantly higher number of MBPs receiving care ( P < .001) and routine services ( P < .001) at the GH. The proportion of MBPs retained in care ( P < .001) and receiving the routine service package ( P < .001) was significantly higher at the private hospital. Overtime, indicators at the private hospital peaked significantly in year 2 and reduced moderately in the final year. The trend for the GH showed gradual but nonsignificant improvement in 2 indicators. QI showed positive results in the private hospital. If systematically applied in GHs, QI can support improved services for larger patient volumes.

scholarly journals Improving a Mother to Child HIV Transmission Programme through Health System Redesign: Quality Improvement, Protocol Adjustment and Resource Addition

PLoS ONE ◽  
2010 ◽  
Vol 5 (11) ◽  
pp. e13891 ◽  
Author(s):  
Michele S. Youngleson ◽  
Paul Nkurunziza ◽  
Karen Jennings ◽  
Juanita Arendse ◽  
Kedar S. Mate ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health System ◽  
Hiv Transmission ◽  
Health System Redesign ◽  
Mother To Child

scholarly journals The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

PLoS ONE ◽  
2013 ◽  
Vol 8 (3) ◽  
pp. e56550 ◽  
Author(s):  
Lorainne Tudor Car ◽  
Serena Brusamento ◽  
Hoda Elmoniry ◽  
Michelle H. M. M. T. van Velthoven ◽  
Utz J. Pape ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hiv Transmission ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mother To Child ◽  
Low And Middle Income

scholarly journals Increasing Access and Adherence to the PMTCT Cascade: Is There a Role for Economic Strengthening Interventions?

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Irina Yacobson ◽  
Morrisa Malkin ◽  
Elena Lebetkin
Keyword(s):  
Pregnant Women ◽  
Hiv Transmission ◽  
Randomised Trial ◽  
Retention In Care ◽  
Economic Barriers ◽  
Research Questions ◽  
Women With Hiv ◽  
Mother To Child ◽  
Economic Strengthening ◽  
Pmtct Cascade

Interventions aimed at prevention of mother-to-child transmission (PMTCT) of HIV are extremely effective but remain underutilized in many countries. Common economic barriers to PMTCT experienced by pregnant women with HIV are well documented. Addressing these economic barriers has a potential to improve PMTCT utilization and further reduce mother-to-child HIV transmission. This review examines the evidence of the effects economic strengthening (ES) interventions have on use of and adherence to PMTCT and other health services relevant to PMTCT cascade. While very few studies on ES interventions were conducted in PMTCT settings, the results of a recent randomised trial demonstrate that conditional cash transfers offered to women in PMTCT programme can significantly improve retention in care and adherence to treatment. This review also considers evidence on ES interventions conducted within other health care settings relevant to PMTCT cascade. While the evidence from other settings is promising, it may not be fully applicable to PMTCT and more quality research on ES interventions among population of pregnant women with HIV is needed. Answering some of the research questions formulated by this review can provide more evidence for programme implementers and guide decisions about how to increase women’s use of and adherence to PMTCT services.

scholarly journals Female perspectives of male partners’ inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal

Curationis ◽  
2016 ◽  
Vol 39 (1) ◽  
Author(s):  
Mondli Miya ◽  
Tennyson Mgutshini
Keyword(s):  
Pregnant Women ◽  
Hiv Transmission ◽  
Public Hospitals ◽  
Sub Saharan Africa ◽  
Child Health Services ◽  
Mother To Child Transmission ◽  
Male Partners ◽  
Child Transmission ◽  
Financial Investment ◽  
Mother To Child

Background: The South African government intervened by implementing the prevention of mother–to-child transmission programme (PMTCT) to curb the HIV transmission from mother to child during and after pregnancy. The PMTCT programme has been at the forefront of global prevention efforts since 1998. Without treatment, the risk of transmission ranges from one in five to one in two newborns; however, the risk of mother-to-child transmission can be reduced to as low as 2%–5% with evidenced interventions. Sub-Saharan Africa, and most particularly South Africa, is the most affected by the pandemic despite having the largest financial investment in PMTCT services across the continent.Objectives: The objectives of the study were to describe and explore the female perspectives of male inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal.Methodology: A qualitative, descriptive, explorative study was conducted through in-depth individual interview of pregnant women until data saturation.Results: The findings of the study revealed that the existing design of public hospitals was not wholly conducive to facilitating male inclusion in maternal and child health services. Resources were largely insufficient to support the participation of pregnant mothers and any attempts to support the inclusion of males needed to be based on a clear increase in service provision.Conclusion: The study recommended male partners’ inclusion in the prevention of mother- to-child HIV transmission to support effective management of HIV in pregnancy and PMTCT programmes. The inclusion of men will provide the holistic support needed by pregnant women on PMTCT programmes.

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