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

Abstract

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.

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

“…20 Teams in all countries were able to successfully use QI approaches to improve retention in care of mother-infant pairs and improve processes of care during clinic visits. 15 The number of HEI retained in care and whose status was known at the time of discharge from the EID program increased dramatically in Tanzania and Uganda over the course of the QI intervention.…”

“…Detailed information on the support provided to the QI teams, and the changes that they made to deliver better care are provided in the JIAPAC-18-08-SA-1100 paper in this supplement, 15 and data on processes of care are described in the country papers (JIAPAC-18-08-SA-1103, 1104, and 1105). In summary, the type of support provided varied among countries, but in general, it consisted of (1) initial training on new prevention of MTCT (PMTCT) guidelines and the basic concepts of QI (5-day classroom training in Kenya and Tanzania, 1-day on-site training in Uganda) and (2) on-site support from trained QI coaches to help teams apply the QI skills they learned in the classroom to their setting.…”

Relation Between Quality Improvement Collaboratives and Non-technical Skills Development: a Systematic Review of Complex Interventions

“…Two studies involved 2 or more countries. [43,46] The great diversity of problems addressed in health structures with different levels of complexity and participation of professionals, sometimes from management, sometimes from patient care, characterised the set of complex interventions in this review. The characteristics of the studies are detailed in Table Asee Additional le 1 for the original data used to perform this analysis.…”

“…[30,38] Improvement of patient safety culture was the subject of three studies. [23,25,36] Improving care in different clinical conditions was the subject of 14 reports such as: neonatal death, [42] care with tracheostomies, [46] diagnosis, [41] child health, [18,27,45] HIV transmission or treatment, [16,22,43] mental health, [24] women's health, [31,34,44] and stroke. [48] Prevention of adverse events was the subject of four studies.…”

“…[48] Prevention of adverse events was the subject of four studies. [28,32,33,36] Collaboratives were effective in improving the intended outcomes by 76.5% (26/34), [16,17,20-27, 29-34,36-38,40-42,44-47] reached partial results in 14.7 % (5 /34), [19,28,35,43,48] and did not obtain the desired improvement in 8.8% (3/34). [15,18,39] Improvement sustainability was reported in 10 of the 26 studies with positive results.…”