USAID World Breastfeeding Week Webinar Series: Every day ... · USAID World Breastfeeding Week ....

USAID World Breastfeeding Week Webinar Series: Every day at 9-10AM EDT

July 31st : Barriers to Breastfeeding: Findings From a Systematic Review of Practices in 20 countries August 1st: Working Together to Save Lives in Emergencies: Initiatives and Tools to Support Breastfeeding in Emergencies August 2nd: The Global Partnership for HIV-Free Survival: Quality Improvement and Breastfeeding/ART Compliance August 3rd: Human Milk Feeding for Small/Sick Newborns August 4th: Revitalizing the Baby Friendly Hospital Initiative: Experiences from Malawi

For more information, visit: http://www.fsnnetwork.org/world-breastfeeding-week-august-1-7-2017-webinar-day-series

ADDITIONAL RESOURCES USAID Global Health: https://www.usaid.gov/what-we-do/global-health USAID Multi-sectoral Nutrition Strategy: https://www.usaid.gov/nutrition-strategy Breastfeeding Symposium: https://www.fantaproject.org/news-and-events/registration-usaid-breastfeeding-symposium-august-29-2016 Breastfeeding Seminar: http://www.fsnnetwork.org/breastfeeding-seminar-protecting-promoting-and-supporting-breastfeeding-field

https://www.usaid.gov/what-we-do/global-health

https://www.usaid.gov/what-we-do/global-health

https://www.usaid.gov/nutrition-strategy



https://www.fantaproject.org/news-and-events/registration-usaid-breastfeeding-symposium-august-29-2016

















http://www.fsnnetwork.org/breastfeeding-seminar-protecting-promoting-and-supporting-breastfeeding-field















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The Global Partnership for HIV-Free Survival (PHFS): Quality Improvement and Breastfeeding /

ART compliance

World Breastfeeding Week Webinar Series | August 2, 2017

Amy F. Stern Improvement Director University Research

Company

Tamara Nsubuga-Nyombi Senior Improvement Advisor

University Research Company

Linda Kisaakye Program Officer

Ministry of Health, Uganda

USAID Applying Science to Strengthen and Improve Systems

PMTCT Maternal Care Spectrum from Pregnancy to 18 months Post Partum

Non-pregnant: Family planning (FP) counseling Preconception Care Partner HIV testing

Antepartum:

PITC in ANC CD4 Testing ART treatment or prophylaxis Adherence support Infant feeding (IF) counseling Safe Motherhood Birth Preparedness

Intrapartum: PITC in L&D CD4 testing ARV prophylaxis Safe Delivery IF counseling FP counseling Adherence support

1-8 Weeks Post

Partum: Maternal postpartum follow-up Enrollment into HIV care ART treatment or prophylaxis during BF FP counseling IF counseling Adherence support

2-6 Months Post

Partum: Repeat CD4 (6 months pp) ART treatment or BF prophylaxis FP counseling IF counseling Adherence support

6-9 Months Post Partum:

ART treatment or BF prophylaxis FP counseling IF counseling Adherence support


ART treatment or BF prophylaxis FP counseling IF counseling Adherence support


ART treatment FP counseling Adherence support Repeat CD4

The PMTCT care spectrum

4

Effective PMTCT includes a series of biomedical and psychosocial interventions administered throughout the

reproductive life of the woman living with HIV

USAID Applying Science to Strengthen and Improve Systems Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response

Drop of ARV uptake before and after delivery

38% 51%

5


The Partnership for HIV-Free Survival

6

• PHFS in six countries: Uganda, Tanzania, Kenya, Lesotho, Mozambique, South Africa

• AIM: Decrease HIV transmission & improve nutrition, infant feeding

• Deliberate focus on in-country and cross-country learning

• Design for sustainability – country owned & led

ASSIST QI demonstration sites Kenya - 16

Lesotho - 12 Tanzania - 30 Uganda - 22


The Partnership for HIV-Free Survival

7

Nutrition in 1st 1000 days (optimal

infant feeding, nutrition and

health practices)

Option B+ (effective ARVs to

reduce HIV transmission)

HIV-free survival of

infants born to HIV-infected mothers

USAID Applying Science to Strengthen and Improve Systems 8

Improvement approach

• Engages teams of providers and other staff

• Focuses on client needs • Analyzes systems and

processes • Empowers teams to make

changes to improve outcomes

• Guided by data to measure results

• Peer-to-peer learning Langley et al, 1999, The Improvement Guide


Basics of collaborative improvement

QI team

site

Site-level summary QI team

LearningSession

representative

Site-level testing of changes and analysis of results

9

QI team

site

QI team

site

QI team

site

QI team

site

QI team

siteQI team

site

QI team

site

Collaborative-level sharing and synthesis of best practices

QI team

site

QI team

site

Multiple sites simultaneously testing changes, common indicators, peer learning about how to improve that area of care


Applying improvement to achieve HIV-free survival

WHAT ARE WE TRYING TO ACHIEVE? • HIV-positive mothers who are alive and in care

• Exposed infants who are HIV-free, alive and in care

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Improve data system to identify areas for

improvement Improve retention of mother-baby pairs

Provide critical package of care at ROUTINE VISITS

Provide critical package of care at

SPECIAL VISITS (6w PCR and results visit, 6

and 12m visit, 18m visit)


Retention of mother-baby pairs at baseline and end of intervention

11

0.8%

66%

1%

82%

4.6%

91%

2.2%

92%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline End of intervention

Percentage of mother-baby pairs retained in care, at baseline and end of intervention

Kenya Lesotho Tanzania Uganda


SO…WHAT HAPPENED TO THE IYCF?

12

Infant and young child feeding (IYCF) results


Defining a standard package of care to be given at each visit

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Tally Sheet for Routine Visits

Mother’s ART CTX/ NVP (baby< 6 weeks) given IYCF counselling done? (Specify

topic) Nutrition assessment for mother

and baby? Appointment for next visit given

and explained what will happen at next visit?

USAID Applying Science to Strengthen and Improve Systems 14

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

May-13 Aug-13 Nov-13 Feb-14 May-14 Aug-14 Nov-14 Feb-15 May-15 Aug-15

3 comparison sites 22 PHFS sites

0500

10001500

May-13 Aug-13 Nov-13 Feb-14 May-14 Aug-14 Nov-14 Feb-15 May-15 Aug-15

Number of HIV positive pregnant and lactating mothers attending in the reporting period (PHFS sites)Number of HIV positive pregnant and lactating mothers attending in the reporting period (comparison)

Percentage of HIV-positive mothers who receive IYCF counselling at each visit, 22 PHFS sites and 3 comparison sites, Uganda


Increasing adherence to IYCF practices, 22 sites, Uganda

15

0%10%20%30%40%50%60%70%80%90%

100%

Apr-13 Jul-13 Oct-13 Jan-14 Apr-14 Jul-14 Oct-14 Jan-15 Apr-15 Jul-15

Percentage of exposed infants reporting to be adhering to recommended IYCF practices in Uganda

010002000

Apr-13 Jul-13 Oct-13 Jan-14 Apr-14 Jul-14 Oct-14 Jan-15 Apr-15 Jul-15

Denominator: Number of exposed infants who attend the EID care point in the given month


Improving IYCF adherence at scale

16


Providing the standard package of care at scale

17


What we know now

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Interpersonal relations are key For mothers, patient-provider relations centered on quality education and counseling and motivating patients to remain in care. For many women, more counseling on how to maintain a healthy lifestyle and keep their babies HIV-free were important improvements in the quality of services.

For some mothers, the quality of services before the introduction of improvement methods was fine, but they were able to point out areas where there had been changes. One woman noted that while “services were fine and satisfactory”, changes included providing counseling at every visit, and providing both mother and baby medications at the same visit.

Mothers are able to describe the changes in quality Improved and more frequent education on treatment adherence and feeding practices was also noted as a valuable change. For many women, more counseling on how to maintain a healthy lifestyle and keep their babies HIV-free was an important improvement in the quality of services


Sustaining improvement at the national level

National evaluation of the MBCP found: • 90% of facilities were providing

services as per guidelines. • Consistency in services

reported and actual services received by mothers.

• Health education, IYCF counselling and ARV refills were almost universal in all facilities.

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Improving processes can improve outcomes

20

% of HEI in PMTCT programs who are alive at 18 months and HIV-

positive Denominator: Average of 56 babies discharged

from EID care point each month

1.6%

% of mother-baby pairs retained in care

Denominator: Average of 1513 MB pairs who should be accessing

care each month

91%

% of mother-baby pairs who receive a standard package

of care at routine visits Denominator: Average of 1034 mother-baby pairs

seen each month

100%

Global target of <5% transmission

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan-13 Apr-13 Jul-13 Oct-13 Jan-14 Apr-14 Jul-14 Oct-14 Jan-15 Apr-15 Jul-15

Key results from PHFS in Uganda


In summary, the key lessons learned

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Robust data system

Retain mother-baby pairs in

care

Provide a standard

package of care

Early initiation on ART

Empower mothers and

create supportive systems


Acknowledgements

• The support of the American people through USAID

• Tim Quick, USAID

• U.S. President’s Emergency Plan for AIDS Relief

• WHO and UNICEF

• PHFS partners IHI, FANTA and LIFT

• Country implementing partners

• USAID ASSIST project staff and MOH counterparts in Uganda

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For more information about PHFS quality improvement

Amy Stern: [email protected] Anisa Ismail: [email protected]

Tim Quick: [email protected]

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To view the PHFS learning platform, visit:

https://www.usaidassist.org/toolkits/partnership-hiv-free-survival-

learning-platform

mailto:[email protected]



https://www.usaidassist.org/toolkits/partnership-hiv-free-survival-learning-platform



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