The prevention of mother-to-child transmission of HIV cascade analysis tool: supporting health managers to improve facility-level service delivery

Sarah Gimbel, Joachim Voss, Mary Anne Mercer, Brenda Zierler, Stephen Gloyd, Maria de Joana Coutinho, Florencia Floriano, Maria de Fatima Cuembelo, Jennifer Einberg, Kenneth Sherr, Sarah Gimbel, Joachim Voss, Mary Anne Mercer, Brenda Zierler, Stephen Gloyd, Maria de Joana Coutinho, Florencia Floriano, Maria de Fatima Cuembelo, Jennifer Einberg, Kenneth Sherr

Abstract

Background: The objective of the prevention of Mother-to-Child Transmission (pMTCT) cascade analysis tool is to provide frontline health managers at the facility level with the means to rapidly, independently and quantitatively track patient flows through the pMTCT cascade, and readily identify priority areas for clinic-level improvement interventions. Over a period of six months, five experienced maternal-child health managers and researchers iteratively adapted and tested this systems analysis tool for pMTCT services. They prioritized components of the pMTCT cascade for inclusion, disseminated multiple versions to 27 health managers and piloted it in five facilities. Process mapping techniques were used to chart PMTCT cascade steps in these five facilities, to document antenatal care attendance, HIV testing and counseling, provision of prophylactic anti-retrovirals, safe delivery, safe infant feeding, infant follow-up including HIV testing, and family planning, in order to obtain site-specific knowledge of service delivery.

Results: Seven pMTCT cascade steps were included in the Excel-based final tool. Prevalence calculations were incorporated as sub-headings under relevant steps. Cells not requiring data inputs were locked, wording was simplified and stepwise drop-offs and maximization functions were included at key steps along the cascade. While the drop off function allows health workers to rapidly assess how many patients were lost at each step, the maximization function details the additional people served if only one step improves to 100% capacity while others stay constant.

Conclusions: Our experience suggests that adaptation of a cascade analysis tool for facility-level pMTCT services is feasible and appropriate as a starting point for discussions of where to implement improvement strategies. The resulting tool facilitates the engagement of frontline health workers and managers who fill out, interpret, apply the tool, and then follow up with quality improvement activities. Research on adoption, interpretation, and sustainability of this pMTCT cascade analysis tool by frontline health managers is needed.

Trial registration: ClinicalTrials.gov NCT02023658, December 9, 2013.

Figures

Figure 1
Figure 1
Map of Sofala Province, Mozambique.
Figure 2
Figure 2
PMTCT cascade analysis tool (screen shot).

References

    1. Siegfried N, van der Merwe L, Brocklehurst P, Sint TT. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Syst Rev. 2011;7:CD003510.
    1. McKenna MT, Hu X. Recent trends in the incidence and morbidity that are associated with perinatal human immunodeficiency virus infection in the United States. Am J Obstet Gynecol. 2007;197(3 Suppl):S10–S16. doi: 10.1016/j.ajog.2007.02.032.
    1. Lindegren ML, Byers RH, Jr, Thomas P, Davis SF, Caldwell B, Rogers M, Gwinn M, Ward JW, Fleming PL. Trends in perinatal transmission of HIV/AIDS in the United States. JAMA. 1999;282(6):531–538. doi: 10.1001/jama.282.6.531.
    1. Padian NS, Holmes CB, McCoy SI, Lyerla R, Bouey PD, Goosby EP. Implementation science for the US President’s Emergency Plan for AIDS Relief (PEPFAR) J Acquir Immune Defic Syndr. 2011;56(3):199–203. doi: 10.1097/QAI.0b013e31820bb448.
    1. Ferguson L, Grant AD, Watson-Jones D, Kahawita T, Ong’ech JO, Ross DA. Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review. Trop Med Int Health. 2012;17(5):564–580. doi: 10.1111/j.1365-3156.2012.02958.x.
    1. World Health Organization . Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector Progress Report. Geneva, Switzerland: World Health Organization; 2011.
    1. UNAIDS . Together We Will End AIDS. Geneva, Switzerland: Joint United Nations Programme on HIV; 2012.
    1. Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med. 1989;320(1):53–56. doi: 10.1056/NEJM198901053200110.
    1. Lamb RM, Studdert DM, Bohmer RM, Berwick DM, Brennan TA. Hospital disclosure practices: results of a national survey. Health Aff. 2003;22(2):73–83. doi: 10.1377/hlthaff.22.2.73.
    1. Smits HL, Leatherman S, Berwick DM. Quality improvement in the developing world. Int J Qual Health Care. 2002;14(6):439–440. doi: 10.1093/intqhc/14.6.439.
    1. Mphatswe W, Mate KS, Bennett B, Ngidi H, Reddy J, Barker PM, Rollins N. Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa. Bull World Health Organ. 2012;90(3):176–182. doi: 10.2471/BLT.11.092759.
    1. Youngleson MS, Nkurunziza P, Jennings K, Arendse J, Mate KS, Barker P. Improving a mother to child HIV transmission programme through health system redesign: quality improvement, protocol adjustment and resource addition. PLoS One. 2010;5(11):e13891. doi: 10.1371/journal.pone.0013891.
    1. Doherty T, Chopra M, Nsibande D, Mngoma D. Improving the coverage of the PMTCT programme through a participatory quality improvement intervention in South Africa. BMC Public Health. 2009;9:406. doi: 10.1186/1471-2458-9-406.
    1. Mate KS, Ngubane G, Barker PM. A quality improvement model for the rapid scale-up of a program to prevent mother-to-child HIV transmission in South Africa. Int J Qual Health Care. 2013;25(4):373–380. doi: 10.1093/intqhc/mzt039.
    1. Barker PM, Mphatswe W, Rollins N. Antiretroviral drugs in the cupboard are not enough: the impact of health systems’ performance on mother-to-child transmission of HIV. J Acquir Immune Defic Syndr. 2011;56(2):e45–e48. doi: 10.1097/QAI.0b013e3181fdbf20.
    1. Wendt D. Health System Rapid Diagnostic Tool. Durham, NC: FHI 360; 2013.
    1. Micek MA, Gimbel-Sherr K, Baptista AJ, Matediana E, Montoya P, Pfeiffer J, Melo A, Gimbel-Sherr S, Johnson W, Gloyd S. Loss to follow-up of adults in public HIV care systems in central Mozambique: identifying obstacles to treatment. J Acquir Immune Defic Syndr. 2009;52(3):397–405. doi: 10.1097/QAI.0b013e3181ab73e2.
    1. Mate KS, Bennett B, Mphatswe W, Barker P, Rollins N. Challenges for routine health system data management in a large public programme to prevent mother-to-child HIV transmission in South Africa. PLoS One. 2009;4(5):e5483. doi: 10.1371/journal.pone.0005483.
    1. Committee on Engineering and the Health Care System . Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: National Academy of Engineering, Institute of Medicine; 2005.
    1. Young PW, Mahomed M, Horth RZ, Shiraishi RW, Jani IV. Routine data from prevention of mother-to-child transmission (PMTCT) HIV testing not yet ready for HIV surveillance in Mozambique: a retrospective analysis of matched test results. BMC Infect Dis. 2013;13:96. doi: 10.1186/1471-2334-13-96.
    1. Barron P, Pillay Y, Doherty T, Sherman G, Jackson D, Bhardwaj S, Robinson P, Goga A. Eliminating mother-to-child HIV transmission in South Africa. Bull World Health Organ. 2013;91(1):70–74. doi: 10.2471/BLT.12.106807.
    1. Gimbel S, Micek M, Lambdin B, Lara J, Karagianis M, Cuembelo F, Gloyd SS, Pfeiffer J, Sherr K. An assessment of routine primary care health information system data quality in Sofala Province, Mozambique. Popul Health Metr. 2011;9:12. doi: 10.1186/1478-7954-9-12.
    1. Hoek R, Quembo T, Afonso P, Porthe V, Michel C, Cliff J, Cuembelo F, Gimbel S, Sherr K, Karagianis M, Pio A, Macuacua F, Manuel J. Avaliacao de quatro indicadores de rotina de cuidados de saude na Provincia de Sofala. In. Beira: Centro de Pesquisa Operacional da Beira; 2013.
    1. Shaw V. Health information system reform in South Africa: developing an essential data set. Bull World Health Organ. 2005;83(8):632–636.
    1. Instituto Nacional de Estatistica . Censo Nacional. Maputo: Instituto Nacional de Estatistica; 2007.
    1. Instituto Nacional de Saude . Inquerito Nacional de SIDA. Maputo: Instituto Nacional de Saude; 2009.
    1. Ferguson L, Grant AD, Watson-Jones D, Kahawita T, Ong'ech JO, Ross DA. Trop Med Int Health. 2012. Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review.
    1. Sherr K, Gimbel S, Rustagi A, Nduati R, Cuembelo F, Farquhar C, Wasserheit J, Gloyd S. Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial. Implement Sci. 2014;9:55. doi: 10.1186/1748-5908-9-55.
    1. Direccao Nacional de Saude Publica . Relatório da Avaliação Nacional do Programa PTV. Maputo: Ministerio de Saude; 2012.
    1. World Health Organization . Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization; 2013.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit