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 buildingProvide 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 documentationReview 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 engagementProvide 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 improvementsDevelop 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 engagementEngage 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.