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.