Figures & Tables
Figures
- FIGURE 1
Illustrative Cascade of Interventions Needed to Prevent Mother-to-Child Transmission of HIV, Diagnose Infants With HIV, and Link Infants to Antiretroviral Therapy
Abbreviations: ART, antiretroviral therapy; EID, early infant diagnosis of HIV; HEI, HIV-exposed infants; HF, health facility.
- FIGURE 2
Quality Improvement Collaborative Approach Used to Improve Early Infant Diagnosis and Antiretroviral Therapy Initiation and Health Facilities in Cameroon and Zambiaa
Abbreviations: QI, quality improvement; QIC, quality improvement collaborative.a Adapted from the Institute for HealthCare Improvement Breakthrough Series.
- FIGURE 3
Improvements in Early Testing, Timely Return of Test Results, and Antiretroviral Initiation From Baseline to Endline After Implementing a Quality Improvement Collaborative Approach, Cameroon and Zambia
Tables
- TABLE 1.
HIV Prevalence, Antiretroviral Therapy Coverage, and Early Infant Diagnosis of HIV Coverage in Cameroon and Zambia, 2018 Data
Cameroon, % Zambia, % Adult HIV prevalence (15–49 years) 3.6 11.3 HIV incidence (all ages) 1.02 2.97 Adults on ART (ages 15–49 years) 55 78 Children on ART (ages 0–14 years) 24 79 Pregnant women accessing ART for PMTCT 80 95 EID coverage (infants tested for HIV at <8 weeks of age) 61 71 Abbreviations: ART, antiretroviral therapy; EID, early infant diagnosis; PMTCT, prevention of mother-to-child transmission of HIV.
- TABLE 2.
Design of Quality Improvement Collaborative Indicators Used in Cameroon and Zambia to Improve Early Infant Diagnosis of HIV and Antiretroviral Therapy Initiation
Cameroon Zambia EID testing coverage and timing Percentage of eligible HEIs who received EID testing at <8 weeks of age Percentage of HEIs tested who received EID testing at <8 weeks of age Number of eligible HEIs tested for HIV at >8 weeks of age Number of HEIs tested for HIV at >8 weeks of age Number of eligible HEIs tested each month Number of HEIs tested each month Test results return to caregiver Percentage of HEIs tested who were identified as HIV infected each month Percentage of HEIs tested who were identified as HIV infected each month Percentage of all HEI HIV test results returned to caregiver this month Percentage of HEIs identified as HIV infected whose caregivers received their results this month Turnaround time Mean time from health facility receiving HEI HIV test results from national laboratory and sharing with caregiver Mean time between positive EID HIV test result and ART initiation ART initiation Percentage of HIV-infected infants newly initiated on ART each month Percentage of HIV-infected infants initiated on ART each month Percentage of HIV-infected infants initiated on ART the same day their positive test was received each month Percentage of HIV-infected infants initiated on ART within 2 weeks of receiving positive test results each month Abbreviations: ART, antiretroviral therapy; EID, early infant diagnosis; HEI, HIV-exposed infant.
- TABLE 3.
Cameroon and Zambia Change Ideas Shared With Stakeholders After 15 Months of Implementation of a Quality Improvement Collaboration to Improve Early Infant Diagnosis of HIV and Antiretroviral Therapy Initiation
Health care worker capacity building Provide on-the-job mentorship to optimize PMTCT services Demonstrate proper DBS sample collection for HF staff in MCH, labor, and postnatal wards, as needed Orient new lay counselors on standard documentation and register completion Pair lay counselors based on experience levels to enable peer-to-peer learning Data quality and documentation Review registers monthly and provide refresher trainings to fill gaps, as needed Reinforce proper documentation practices among all MCH lay counselors Enlarge and display national register standard operating procedures Assign nurses to supervise lay counselor documentation practices Confirm and update caregiver contact information with every visit Conduct quarterly reviews for data quality in relevant registers Client and family education and engagement Provide targeted, one-on-one health education talks to HIV-infected mothers Deliver HF invitations to increase male partner involvement/participation in MCH services Recruit and engage mentor mothers to provide health education from the peer perspective Provide one-on-one health information and counseling to HIV-infected mothers regarding male involvement in care and the importance of disclosure Male partner engagement during ANC visits for all education provided Introduce a “care buddy” to increase retention in care where clients attend treatment preparation sessions with a friend, family member, or support person to help with treatment adherence Workflow process improvements Develop and use DBS tracking forms between ANC and laboratory departments Develop and display a flowchart to illustrate MOH standard of care Prioritize immediate action on positive HIV test results received from laboratory Develop interfacility communication system to enable confirmed patient transfers Assign HIV test (DBS) stock management focal persons Active HEI case finding through retrospective ANC chart review and follow up Engage the facility-based “linkage officer” to facilitate communication of DBS HIV test results with MCH staff Screen postnatal discharge cards upon arrival at postnatal care for HIV testing Develop and use a tracking list to follow up on missing DBS results Designate specific days to prioritize the provision of EID and ANC services Community engagement Engage community-based volunteer peer mothers in active tracking and follow-up Introduce geographic HIV-infected pregnant women social networks Convene sensitization meetings to engage religious leaders in the community Engage safe mother action groups in tracking and follow-up activities Abbreviations: ANC, antenatal care; ART, antiretroviral therapy; DBS, dried blood sample; EID, early infant diagnosis; HEI, HIV-exposed infant; HF, health facility; MCH, maternal child health; MOH, Ministry of Health; PMTCT, prevention of mother-to-child transmission of HIV.
- TABLE 4.
Improvements in Early Infant Diagnosis, Timely Return of Test Results, and Antiretroviral Initiation From Baseline to Endline After Implementing a Quality Improvement Collaborative Approach, Cameroon
Indicators Baseline Oct.
2015–Feb. 2016Implementation
Mar. 2016–Jun. 2017Endline
Feb. 2017–Jun. 2017Change
Base to EndEID testing Eligible HEIs who received EID DBS at <8 weeks of age, % 57 71 82 24 Eligible HEIs who received EID DBS at >8 weeks of age, % 42 29 20 −22 Return of test results HEIs tested who were identified as HIV infected, % 2 6 4 2 All HEIs tested whose EID DBS PCR test results were documented and shared with caregiver, % 18 81 86 68 Mean time from facility receiving results from laboratory to results being reported to caregiver, days 19 8 3 −16 ART initiation HIV-infected infants newly initiated on ART, % 33 51 89 56 Abbreviations: ART, antiretroviral therapy; DBS, dried blood sample; EID, early infant diagnosis; HEI, HIV-exposed infant; PCR, polymerase chain reaction.
- TABLE 5.
Improvements in Early Infant Diagnosis, Timely Return of Test Results, and Antiretroviral Initiation From Baseline to Endline After Implementing a Quality Improvement Collaborative Approach, Zambia
Indicators Baseline
Jan. 2016–Dec. 2016Implementation
Mar. 2017–May 2018Endline
Mar. 2018–May 2018Change
Base to EndEID testing HEIs who received EID DBS at <8 weeks of age, % 77 84 89 12 HEIs who received EID DBS at >8 weeks of age, % Return of test results HEIs tested who were identified as infected, % 3 3 2 −1 HEIs identified as infected who received their results, % 44 86 79 35 Mean time between positive EID DBS result and initiating ART, days 48 14 9 −39 ART initiation HIV-infected infants initiated on ART, % 44 83 80 36 HIV-infected infants initiated on ART the same day positive test were received, % 12 18 11 −1 HIV-positive infants initiated on ART within 2 weeks of receiving positive test results, % 23 61 71 48 Abbreviations: ART, antiretroviral therapy; DBS, dried blood sample; EID, early infant diagnosis; HEI, HIV-exposed infant; PCR, polymerase chain reaction.
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