the e

Poster No. PE434
UGANDANS AND AMERICANS
IN PARTNERSHIP TO FIGHT HIV/AIDS
How Can We Keep HIV-positive Mothers and Their Babies in Care Until the Baby is 18 Months Old?
Results of an eMTCT Collaborative in 22 Health Facilities in Uganda
Tamara Nsubuga-Nyombi, Esther Karamagi-Nkolo, Joyce Draru, Humphrey Megere
University Research Co. LLC (URC)/USAID Applying Science to Strengthen and Improve Systems (ASSIST)
Introduction
T
he USAID Applying Science to Strengthen and Improve
Systems (ASSIST) supported the Uganda Ministry of
Health to use quality improvement (QI) to improve the quality
of services provided to HIV-positive mothers and their babies.
When improvement work began at 22 demonstration health
facilities in 6 districts in April 2013, only 2.2% (39 out 1800)
mother-baby pairs expected to be in postnatal care were in
care. If mother-baby pairs are not in care postnatally, they do
not receive essential eMTCT services. Quality improvement
efforts thus focused on increasing retention of mother-baby
pairs postnatally so that these mother-baby pairs could
receive all the essential eMTCT services such as ART for the
mother, cotrimoxazole for the baby, infant and young child
feeding counselling and nutrition assessment.
Results
R
etention of mother-baby pairs in care monthly improved
from 2.2% at baseline in April 2013 to 62.4% in 22 sites in
April 2014. Changes tested by teams included merging the
mother’s (ART) and baby’s (EID) clinic so the pair were seen
simultaneously, keeping mothers’ and babies’ clinic records
together, consistently checking for HIV status at immunization
and linking positives to postnatal services. Changes tested
to address issues beyond facility walls included finding lost
mothers using phone calls, use of peers and community
health workers to trace them, and asking male partners to
attend the clinics through family support groups.
Figure 1 compares the improvement in the retention of
mother-baby pairs in all the 22 health facilities in the eMTCT
collaborative from April 2013-April 2014 and improvement in
one selected health facility over time.
Figure 1. Percentage of mother-baby pairs retained in care monthly at
22 health facilities and at 1 health facilities, April 2013 – April 2014,
Uganda Partnership for HIV-Free Survival Improvement collaborative
100%
Method
90%
Acknowledgements
This work was supported by the American people through the United States Agency for International
Development (USAID) with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and
implemented by the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, managed
by University Research Co., LLC (URC) under the terms of Cooperative Agreement AID-OAA-A-12-00101. For
more information, please visit www.usaidassist.org or contact assist-info@urc-chs.com. The authors’ views
expressed in this poster do not necessarily reflect the views of USAID or the United States Government.
Percentage MB pairs retained in 1 site
80%
F
ollowing consultative meetings with stakeholders to agree
on definitions and tools, a baseline assessment was
conducted in all 22 facilities. Quality improvement teams at
site level were either newly formed or reconstituted based
on their functionality and constitution at baseline. Through
site visits by coaches, site teams identified root causes of
poor retention of mother-baby pairs. Coaches also shared
change ideas to improve retention. Site teams then tested
chosen changes on a small scale and recorded their results
in a standard documentation journal. Improvement teams
tested changes and shared results in peer-to- peer learning
sessions. Coaching, implementing changes, and learning
sessions were key methods used to improve retention in care.
Percentage of MB pairs retained in all 22 sites
70%
60%
50%
A Peer-to-peer learning session in progress; participants sharing what
changes they have tested and using their data to demonstrate improvement.
Photos by Tamara Nsubuga-Nyombi, URC
40%
30%
20%
10%
0%
Baseline
May
June
2013
July
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
2014
Conclusion
M
others and their babies must be kept in care as a pair
so that each pair receives care services which will
contribute to elimination of new infections. Changing the
system of care for mothers and their babies and improving
the documentation process can lead to improved retention
of mother-baby pairs in care. These system changes will be
spread to additional sites in the scale up phase.