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 Cost-effectiveness of World Health Organization 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in Zimbabwe

2012 ◽  
Vol 56 (3) ◽  
pp. 430-446 ◽  
Author(s):  
Andrea L. Ciaranello ◽  
Freddy Perez ◽  
Barbara Engelsmann ◽  
Rochelle P. Walensky ◽  
Angela Mushavi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
World Health Organization ◽  
Hiv Transmission ◽  
World Health ◽  
Health Organization ◽  
Mother To Child

scholarly journals Infant feeding counseling within Kenyan and Zambian PMTCT services: How well does it promote good feeding practices?

2003 ◽  
Keyword(s):  
Infant Feeding ◽  
Hiv Transmission ◽  
World Health ◽  
Local Context ◽  
Feeding Practice ◽  
Provider Attitudes ◽  
Hiv Positive Mothers ◽  
Nondirective Counseling ◽  
Health Organization ◽  
Mother To Child

Infant feeding counseling is an important intervention for the prevention of mother-to-child transmission (PMTCT) of HIV. More than one-third of HIV transmission to infants occurs through breastfeeding, and up to 20 percent of infants born to HIV-infected mothers acquire the virus from breast milk in countries where extended breastfeeding of children is the norm. The World Health Organization advises that HIV-positive mothers should be offered nondirective counseling on various infant feeding options that are feasible, affordable, safe, sustainable, and effective in the local context. The Horizons Program collaborated with NARESA in Kenya, the MTCT Working Group in Zambia, and UNICEF to examine the implementation of infant feeding counseling as part of a comprehensive study in each country to document the acceptability, operational barriers, cost, and impact of pilot PMTCT services. This brief presents key findings from the Kenya and Zambia studies on the content of counseling, provider attitudes about infant feeding options, and the extent to which actual infant feeding practice by mothers is consistent with recommended practice.

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 Knowledge of HIV and benefits of male medical circumcision amongst clients in an urban area

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Abidemi Faleye
Keyword(s):  
Urban Area ◽  
Hiv Transmission ◽  
World Health ◽  
Routine Practice ◽  
Cross Sectional ◽  
Innovative Methods ◽  
Validated Questionnaire ◽  
Preventative Strategy ◽  
Set Up ◽  
Health Organization

Background: Male medical circumcision (MMC) has been shown to reduce the risk of HIV transmission in circumcised men by up to 60%. Following recommendations from the World Health Organization, South Africa adopted MMC as a preventative strategy against HIV in 2010 and set up circumcision camps across the country. Concerns have been raised about condom avoidance following MMC because of a mistaken belief about the benefits of MMC.Aim and setting: The aim of this study was to describe the profile and knowledge about HIV and circumcision amongst men presenting for MMC in an urban area in KwaZulu-Natal.Methods: This was a cross-sectional descriptive study of 394 clients over the age of 18 years who presented to two MMC sites in Durban between November 2012 and March 2013. A validated questionnaire was used to collect data.Results: The mean age of clients presenting for MMC was 28 years. Most clients were black, single, unemployed and sexually active. The majority presented for MMC because they believed that MMC would reduce their risk of acquiring HIV infection. Knowledge about HIV transmission was very good and 86.3% of clients were aware that risky sexual behaviour suchas condom avoidance could reverse the benefits of MMC.Conclusion: The knowledge of HIV and benefits of MMC was very good amongst those presenting for MMC. However as MMC is primarily a preventative strategy, innovative methods to promote MMC prior to first sexual encounter need to be explored. Further research is needed to determine whether the benefits of MMC on the reduction of HIV transmission aresustained in routine practice. [Full text article to follow]

scholarly journals Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Jean-Bosco Ndihokubwayo ◽  
Talkmore Maruta ◽  
Nqobile Ndlovu ◽  
Sikhulile Moyo ◽  
Ali Ahmed Yahaya ◽  
...  
Keyword(s):  
Quality Improvement ◽  
World Health Organization ◽  
Continuous Quality Improvement ◽  
World Health ◽  
Regional Office ◽  
Quality Improvement Process ◽  
Continuous Quality ◽  
The World ◽  
Health Organization ◽  
World Health Organization Regional

Background: The increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis, management and treatment of diseases. In response, the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program.SLIPTA implementation process: WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1–5 stars were issued.Preliminary results: By March 2015, 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries, competent in the Portuguese (3), French (12) and English (83) languages, were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62–77). Of these audited laboratories, 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action), which both had mean scores below 50%.Conclusion: The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment, ownership and investment in continuous quality improvement are integral components of the process.

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 High Baseline CD4 Count and Exclusive Breastfeeding Are Associated with Lower Rates of Mother to Child HIV Transmission in Northwestern Uganda: A Two-Year Retrospective Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Jonathan Izudi ◽  
Pontius Apangu ◽  
Francis Bajunirwe ◽  
Edgar Mulogo ◽  
Vincent Batwala
Keyword(s):  
Confidence Interval ◽  
Exclusive Breastfeeding ◽  
Odds Ratio ◽  
Associated Factors ◽  
Adjusted Odds Ratio ◽  
Hiv Transmission ◽  
Cd4 Count ◽  
World Health ◽  
High Baseline ◽  
Health Organization

Background. Under Option B plus, the transmission of Human Immunodeficiency Virus (HIV) along the Early Infant Diagnosis (EID) of HIV cascade remains unknown. We described HIV transmission along the EID cascade and determined associated factors at Arua Regional Referral Hospital, Northwestern Uganda. Methods. Data on 295 mother-baby pairs in EID care (January 2014 and April 2015) was extracted, cleaned, and analysed in STATA. Univariate, bivariate, and multivariate analyses were performed. Independently associated factors were stated in adjusted odds ratio (AOR), 95% confidence interval (CI), and p-values. Results. 233 (89.0%) mothers were above 30 years, 251 (85.1%) were in World Health Organization (WHO) clinical stages I/II at enrolment, 170 (57.6%) attended antenatal care (ANC) visits during recent pregnancy, and 204 (69.1%) delivered in a health facility. Meanwhile, 257 (87.1%) HIV Exposed Infants (HEIs) received Nevirapine prophylaxis from birth up to 6 weeks and 245 (83.0%) were exclusively breastfed during the first 6 months. Of 295 mother-baby pairs, 25 (8.5%) HEIs turned HIV-positive along the EID cascade. Baseline maternal CD4 count of more than 500 cells/ul compared to less than 500 cells/ul (adjusted odds ratio (AOR) = 0.29; 95% Confidence Interval (CI): 0.10–0.85; p = 0.024) and exclusive breastfeeding (EBF) in the first 6 months of delivery in contrast to not EBF in the first 6 months (AOR = 0.17; 95% CI: 0.52–0.55; p = 0.003) reduced HIV transmission. Meanwhile, ANC visits, place of delivery, time of Nevirapine initiation, and maternal antiretroviral therapy use were not significantly associated with infant HIV transmission. Conclusion. HIV transmission was high. High baseline CD4 count and exclusive breastfeeding reduced HIV transmission.

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