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Results of an eMTCT Collaborative in 22 Health Facilities ... · How Can We Keep HIV-positive...
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How Can We Keep HIV-positive Mothers and Their Babies in Care Until the Baby is 18 Months Old? Results of an eMTCT Collaborative in 22 Health Facilities in Uganda Tamara Nsubuga-Nyombi, Esther Karamagi-Nkolo, Joyce Draru, Humphrey Megere University Research Co. LLC (URC)/USAID Applying Science to Strengthen and Improve Systems (ASSIST) Introduction T he USAID Applying Science to Strengthen and Improve Systems (ASSIST) supported the Uganda Ministry of Health to use quality improvement (QI) to improve the quality of services provided to HIV-positive mothers and their babies. When improvement work began at 22 demonstration health facilities in 6 districts in April 2013, only 2.2% (39 out 1800) mother-baby pairs expected to be in postnatal care were in care. If mother-baby pairs are not in care postnatally, they do not receive essential eMTCT services. Quality improvement efforts thus focused on increasing retention of mother-baby pairs postnatally so that these mother-baby pairs could receive all the essential eMTCT services such as ART for the mother, cotrimoxazole for the baby, infant and young child feeding counselling and nutrition assessment. UGANDANS AND AMERICANS IN PARTNERSHIP TO FIGHT HIV/AIDS Acknowledgements This work was supported by the American people through the United States Agency for International Development (USAID) with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and implemented by the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, managed by University Research Co., LLC (URC) under the terms of Cooperative Agreement AID-OAA-A-12-00101. For more information, please visit www.usaidassist.org or contact [email protected]. The authors’ views expressed in this poster do not necessarily reflect the views of USAID or the United States Government. Results R etention of mother-baby pairs in care monthly improved from 2.2% at baseline in April 2013 to 62.4% in 22 sites in April 2014. Changes tested by teams included merging the mother’s (ART) and baby’s (EID) clinic so the pair were seen simultaneously, keeping mothers’ and babies’ clinic records Conclusion M others and their babies must be kept in care as a pair so that each pair receives care services which will contribute to elimination of new infections. Changing the system of care for mothers and their babies and improving the documentation process can lead to improved retention of mother-baby pairs in care. These system changes will be spread to additional sites in the scale up phase. Figure 1. Percentage of mother-baby pairs retained in care monthly at 22 health facilities and at 1 health facilities, April 2013 – April 2014, Uganda Partnership for HIV-Free Survival Improvement collaborative Method F ollowing consultative meetings with stakeholders to agree on definitions and tools, a baseline assessment was conducted in all 22 facilities. Quality improvement teams at site level were either newly formed or reconstituted based on their functionality and constitution at baseline. Through site visits by coaches, site teams identified root causes of poor retention of mother-baby pairs. Coaches also shared change ideas to improve retention. Site teams then tested chosen changes on a small scale and recorded their results in a standard documentation journal. Improvement teams tested changes and shared results in peer-to- peer learning sessions. Coaching, implementing changes, and learning sessions were key methods used to improve retention in care. Baseline May June July Aug Sep Oct Nov Dec Jan Feb Mar Apr 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2014 Percentage of MB pairs retained in all 22 sites Percentage MB pairs retained in 1 site A Peer-to-peer learning session in progress; participants sharing what changes they have tested and using their data to demonstrate improvement. Photos by Tamara Nsubuga-Nyombi, URC together, consistently checking for HIV status at immunization and linking positives to postnatal services. Changes tested to address issues beyond facility walls included finding lost mothers using phone calls, use of peers and community health workers to trace them, and asking male partners to attend the clinics through family support groups. Figure 1 compares the improvement in the retention of mother-baby pairs in all the 22 health facilities in the eMTCT collaborative from April 2013-April 2014 and improvement in one selected health facility over time. Poster No. PE434
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Transcript of Results of an eMTCT Collaborative in 22 Health Facilities ... · How Can We Keep HIV-positive...
How Can We Keep HIV-positive Mothers and Their Babies in Care Until the Baby is 18 Months Old?Results of an eMTCT Collaborative in 22 Health Facilities in Uganda
Tamara Nsubuga-Nyombi, Esther Karamagi-Nkolo, Joyce Draru, Humphrey Megere University Research Co. LLC (URC)/USAID Applying Science to Strengthen and Improve Systems (ASSIST)
Introduction
The USAID Applying Science to Strengthen and Improve Systems (ASSIST) supported the Uganda Ministry of
Health to use quality improvement (QI) to improve the quality of services provided to HIV-positive mothers and their babies. When improvement work began at 22 demonstration health facilities in 6 districts in April 2013, only 2.2% (39 out 1800) mother-baby pairs expected to be in postnatal care were in care. If mother-baby pairs are not in care postnatally, they do not receive essential eMTCT services. Quality improvement efforts thus focused on increasing retention of mother-baby pairs postnatally so that these mother-baby pairs could receive all the essential eMTCT services such as ART for the mother, cotrimoxazole for the baby, infant and young child feeding counselling and nutrition assessment.
UGANDANS AND AMERICANSIN PARTNERSHIP TO FIGHT HIV/AIDS
AcknowledgementsThis work was supported by the American people through the United States Agency for International Development (USAID) with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and implemented by the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, managed by University Research Co., LLC (URC) under the terms of Cooperative Agreement AID-OAA-A-12-00101. For more information, please visit www.usaidassist.org or contact [email protected]. The authors’ views expressed in this poster do not necessarily reflect the views of USAID or the United States Government.
Results
Retention of mother-baby pairs in care monthly improved from 2.2% at baseline in April 2013 to 62.4% in 22 sites in
April 2014. Changes tested by teams included merging the mother’s (ART) and baby’s (EID) clinic so the pair were seen simultaneously, keeping mothers’ and babies’ clinic records
Conclusion
Mothers and their babies must be kept in care as a pair so that each pair receives care services which will
contribute to elimination of new infections. Changing the system of care for mothers and their babies and improving the documentation process can lead to improved retention of mother-baby pairs in care. These system changes will be spread to additional sites in the scale up phase.
Figure 1. Percentage of mother-baby pairs retained in care monthly at 22 health facilities and at 1 health facilities, April 2013 – April 2014, Uganda Partnership for HIV-Free Survival Improvement collaborative
Method
Following consultative meetings with stakeholders to agree on definitions and tools, a baseline assessment was
conducted in all 22 facilities. Quality improvement teams at site level were either newly formed or reconstituted based on their functionality and constitution at baseline. Through site visits by coaches, site teams identified root causes of poor retention of mother-baby pairs. Coaches also shared change ideas to improve retention. Site teams then tested chosen changes on a small scale and recorded their results in a standard documentation journal. Improvement teams tested changes and shared results in peer-to- peer learning sessions. Coaching, implementing changes, and learning sessions were key methods used to improve retention in care.
Baseline May June July Aug Sep Oct Nov Dec Jan Feb Mar Apr
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2013 2014
Percentage of MB pairs retained in all 22 sites
Percentage MB pairs retained in 1 site
A Peer-to-peer learning session in progress; participants sharing what changes they have tested and using their data to demonstrate improvement. Photos by Tamara Nsubuga-Nyombi, URC
together, consistently checking for HIV status at immunization and linking positives to postnatal services. Changes tested to address issues beyond facility walls included finding lost mothers using phone calls, use of peers and community health workers to trace them, and asking male partners to attend the clinics through family support groups.
Figure 1 compares the improvement in the retention of mother-baby pairs in all the 22 health facilities in the eMTCT collaborative from April 2013-April 2014 and improvement in one selected health facility over time.
Poster No. PE434
