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

被引:2
作者
Flax, Valerie L. [1 ,2 ]
Kasasa, Simon [3 ]
Ssendagire, Steven [3 ]
Lane, Charlotte [1 ]
Atuyambe, Lynn [3 ]
Lance, Peter M. [1 ]
Ssengooba, Freddie [3 ]
Draru, Joyce [1 ]
Bobrow, Emily A. [1 ]
机构
[1] Univ N Carolina, Carolina Populat Ctr, MEASURE Evaluat, Chapel Hill, NC 27515 USA
[2] RTI Int, Publ Hlth Res Div, Res Triangle Pk, NC USA
[3] Makerere Univ, Sch Publ Hlth, Coll Hlth Sci, Kampala, Uganda
关键词
prevention of mother-to-child transmission; retention in care; quality improvement; evaluation; Uganda; INTERVENTION; RETENTION;
D O I
10.1097/QAI.0000000000002298
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
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 4 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 significant 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 ' quality improvement approach increased EBF, retention in care, and data completeness in demonstration facilities during the program and these benefits were sustained.
引用
收藏
页码:457 / 466
页数:10
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