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

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.

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

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219855631 ◽

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.

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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

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000002298 ◽

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

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A quality improvement model for the rapid scale-up of a program to prevent mother-to-child HIV transmission in South Africa

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzt039 ◽

2013 ◽

Vol 25 (4) ◽

pp. 373-380 ◽

Cited By ~ 25

Author(s):

Kedar S. Mate ◽

Gugu Ngubane ◽

Pierre M. Barker

Keyword(s):

South Africa ◽

Quality Improvement ◽

Hiv Transmission ◽

Scale Up ◽

Mother To Child

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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

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219869309 ◽

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.

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