Using a quality improvement approach in the prevention of mother-to-child HIV transmission program in Uganda improves key outcomes and is sustainable in demonstration facilities: Partnership for HIV-Free Survival


ja-20-280

Author(s): Flax VL, Kasasa S, Ssendagire S, Lane C, Atuyambe L, Lance PM, Ssengooba F, Draru J, Bobrow EA

Year: 2020

Using a quality improvement approach in the prevention of mother-to-child HIV transmission program in Uganda improves key outcomes and is sustainable in demonstration facilities: Partnership for HIV-Free Survival Abstract:

Background: The Partnership for HIV-Free Survival (PHFS) in Uganda used a quality improvement (QI) approach to integrate the prevention of mother-to-child transmission (MTCT) of HIV, maternal and child health, and nutrition services, with the goal of increasing the retention of mother-baby pairs in care and decreasing vertical transmission of HIV.

Methods: This evaluation of PHFS used a retrospective longitudinal design to assess the program’s association with four outcomes. Data were extracted from patient records from 2011 (before the program) to 2018 (after the program) at 18 demonstration, 18 scale-up, and 24 comparison facilities. Difference-in-differences analyses were conducted with significance set at p<0.15 during and p>0.15 or a continued improvement after PHFS.

Results: PHFS was associated with an increase in exclusive breastfeeding (EBF) (p=0.08), 12- month retention in care (p<0.001), and completeness of child 18-month HIV test results (p=0.13) at demonstration facilities during program implementation. MTCT at 18 months decreased but did not differ between groups. Increases in EBF (p=0.67) and retention in care (p=0.16) were sustained, and data completeness (p=0.10) continued to increase at demonstration facilities after the program. PHFS was associated with an increase in EBF (p<0.001) at scale-up facilities, but there was no difference between groups for retention in care, MTCT, or data completeness. Gains in EBF were lost (p=0.08) and retention in care declined (p<0.001) at scale-up facilities after the program.

Conclusion: PHFS’ QI approach increased EBF, retention in care, and data completeness during the program. These benefits were sustained at demonstration but not at scale-up facilities.

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