Elimination of mother-to-child transmission of HIV in South Africa: Rapid scale-up using quality improvement

Abstract

Background. South Africa (SA) is committed to achieving the goal of eliminating mother-to-child transmission (MTCT) of HIV by 2015. To achieve this, universal coverage of quality antenatal, labour, delivery and postnatal services for all women has to be attained. Over the past decade, the prevention of mother-to-child transmission (PMTCT) programme has been scaled up to reach all healthcare facilities in the country. However, challenges persist in achieving 100% coverage and access to the programme. Objectives. We describe the process undertaken by the National Department of Health (NDoH), in collaboration with partners, to develop, implement and monitor a data-driven intervention to improve facility, district, provincial and national PMTCT-related performance. Methods. Between 2011 and 2013, the NDoH developed and implemented an intervention using data-driven participatory processes to understand facility-level bottlenecks to optimise PMTCT implementation and to scale up priority PMTCT actions nationally. Results. There was remarkable improvement across all key indicators in the PMTCT cascade over the 3 years 2011 -2013. Simple monitoring tools such as a visual dashboard and data for action reports were successfully used to improve the performance of the PMTCT programme across SA. MTCT has shown a significant downward trend. Conclusions. It is feasible to implement district-level, data-driven quality improvement processes at a national scale to improve the performance of the PMTCT programme at the local level.

A five-year review of vertical HIV transmission in a specialized service: cross-sectional study

“…The present study did not allow identification of risk factors [14][15][16][17] This demonstrates the importance of early diagnosis and subsequent treatment in order to reduce the risk factors for vertical transmission.…”

“…One factor that helps reduce the possibility of vertical transmission is the use of medication to inhibit lactation, and 95.9% of the pregnant women in this study were found to be using this medication. 4,8,12,[14][15][16][17][18] Use of antiretroviral drugs during pregnancy increases the The cases of 81.1% of the HIV-positive pregnant women were only notified in the third trimester, thus indicating that there were delays in notification. In Brazil, notification is supposed to occur at the time of detection of HIV infection in pregnant women and/ or children infected by vertical transmission.…”

On the path to reach the SDG targets: Decreasing maternal and child mortality in South Africa

“…Previous improvements in the prevention of mother-to-child transmission of HIV (PMTCT) have been well documented. [8][9][10] In their paper, Goga et al [11] show how there have been further decreases in the rate of early (in utero) transmission of HIV from mother to child. Improvements have occurred as a possible result of use of ward-based outreach teams and community caregivers to trace HIV-exposed infants and connect mothers to care.…”

Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

“…Figure 2, adapted from work by Kranzer and Bhardwaj (Kranzer et al 2012;Bhardwaj et al 2014), depicts the integration of community-based MNCH services and PMTCT using CHWs, and includes associated process and impact indicators. Boxes in the grey arrow show the steps along the PMTCT cascade for HIV-infected pregnant women, including lifelong ART.…”