Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement

Kevin Fiori, Jennifer Schechter, Monica Dey, Sandra Braganza, Joseph Rhatigan, Spero Houndenou, Christophe Gbeleou, Emmanuel Palerbo, Elfamozo Tchangani, Andrew Lopez, Emily Bensen, Lisa R Hirschhorn, Kevin Fiori, Jennifer Schechter, Monica Dey, Sandra Braganza, Joseph Rhatigan, Spero Houndenou, Christophe Gbeleou, Emmanuel Palerbo, Elfamozo Tchangani, Andrew Lopez, Emily Bensen, Lisa R Hirschhorn

Abstract

Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo.

Keywords: Pediatric HIV; Togo; care delivery value chain; global healthcare delivery; implementation science.

Figures

Figure 1.
Figure 1.
Care delivery value chain for pediatric HIV services in Kara, Togo in 2014–2015.
Figure 2.
Figure 2.
Schematic model for CDVC/quality improvement integration.

References

    1. Kim J. Y., Farmer P., Porter M. E. Redefining global health-care delivery. The Lancet. 2013;(9897):1060–1069. doi: 10.1016/S0140-6736(13)61047-8.
    1. Porter M., Teisberg E. Redefining health care: Crating value based competition on results. Boston, MA: Harvard Business School Press; 2006.
    1. Rhatigan J., Jain S., Mukherjee J., Porter M. Boston, MA: Harvard Business School; 2009. Applying the care delivery value chain HIV/AIDS care in resource poor settings (Harvard Business School Working Paper)
    1. UNAIDS 2014 Togo country progress report, 2014. Retrieved from .
    1. UNAIDS . AIDS by the numbers 2015. UNAIDS; 2015. Retrieved from .
    1. UNICEF . Children & AIDS: 2015 statistical update. UNICEF; 2015. Retrieved from .

Source: PubMed

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