Post on 02-Jan-2016
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Improving care of HIV-infected breastfeeding mothers and their babies:
Early results from the Partnership for HIV-free Survival Initiative in Uganda
Tamara Nsubuga-Nyombi, URC
IAS- Melbourne, Australia July 22nd, 2014
USAID Applying Science to Strengthen and Improve Systems
The Partnership for HIV-Free Survival
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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
Retention of mother-baby pairs in care
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Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-140%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of mother-baby pairs retained in 22 PHFS sites vs 1 low volume HCIV and 1 high volume HCIV (April 2013- May 2014)
% MB pairs retained in all 22 sites % MB pairs retained in one low volume site % MB pairs retained in one high volume site
Apr: Pairing of mothers and babies
May 13: Merged EID and ART services at one service points and gave same appointment date
Jun 13: Peer mothers involved in counseling mothers on appointment keeping
May 13: Pairing of mothers and babies
Jun 13: Peers escort MB pairs to the clinic
Sep 13: Assigned EID focal person to pair cards and make phone calls to mothers
Dec13: Set specific / separate day to see MB pairs
Jul 13: Family support group meetings used to identify MB pairs and see them then
Nov 13: ART and EID merged so MB pairs receive services in one area
Mar 14: Phone calls to mothers
ChangesAt one low volume site ave. 93 pairs / mo
At one high volume site ave. 170 pairs / mo
USAID Applying Science to Strengthen and Improve Systems
Mother-baby pairs who receive a standard package of care at routine visits
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0%10%20%30%40%50%60%70%80%90%
100%
Percentage of mother-baby pairs who receive a standard package of care at routine visits in 22 sites, June 2013 - April 2014
Percentage at all 22 sites Percentage at one example site
0
500
1000
1500
309
1105
Number of mother-baby pairs seen in all 22 clinicsNumber of mother-baby pairs seen in all 22 clinics
Learning session 2; new client flow chart developed
Merging of ART and EID services
Expert clients trained to do MUAC and assigned responsibility of assessing and nutrition counselling
Mothers told about what services to expect so they can remind HW if they forget a service
Changes made at example site
20 clinics reporting
21 clinics reporting
USAID Applying Science to Strengthen and Improve Systems
Integrating the content and process of providing care
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Content of care
What is done:
Guidelines on IYCF (e.g. all children should be exclusively breastfed for 6 months)
Guidelines on Option B+ (all HIV positive mothers should be initiated on B+)
Process of care
How it is done: • Improve
identification of mothers and babies
• Improve retention in care
• Provide routine services
• Improve IYCF practices and adherence
Output/ outcome
HIV-positive mothers on ART who are doing well
Well nourished, HIV-free babies
USAID Applying Science to Strengthen and Improve Systems
Sequencing and simplifying the approach
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Completeness and accuracy
of EMTCT data
Work on bringing more mothers and
babies to care
Every mother –baby pair gets a
standard package at
routine visits
Monitor the babies’ status; initiate newly identified mothers on
ART
Jun '13 May '14
9
941
Apr' 13 May '14
39
1115
Apr '13 May '14
12 11
29
13
Apr'13 May '14
2.9%
95.4%
USAID Applying Science to Strengthen and Improve Systems
Basics of Collaborative Improvement
QI team
site
Site-level summaryQI team
LearningSession
representative
Site-level testing of changes and analysis of results
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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
USAID Applying Science to Strengthen and Improve Systems
Challenges and what we are learning
Challenges:
• Not all HIV-positive mothers at the different entry points are identified; need to improve linkages and PICT
• 2-3 of 15 HIV-positive mothers do not consent to ART initiation immediately; health workers need to follow-up through phone calls
What we are learning:
• Substantial effort has to be put into retaining mothers and their babies in care for 18 months
• The QI approach enables health workers apply the most effective and efficient changes to improve their work
• Having more entry points, involving the community and merging ART and EID services improves ART coverage, retention and quality of care
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Acknowledgements
The 22 PHFS demonstration sites
The Ministry of Health, PEPFAR, and other partners in Uganda (TASO, JSI-SPRING, EGPAF-STAR SW)
District quality improvement coaches
Colleagues at USAID ASSIST
For more information please contact: Dr. Humphrey Megere, Chief of Party, USAID ASSIST Project, URC Uganda
hmegere@urc-chs.com
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