Partnership for HIV-Free SurvivalLeveraging Quality Improvement to reduce MTCT during the post-natal continuum of care Sarah Olver

APHA5 November 2013

Contents

▪ What is the Partnership for HIV-Free Survival?

▪ Quality improvement and the PHFS learning platform

▪ Early progress of countries

The Partnership is a multi-country learning collaborative

which is part of the global effort towards eMTCT.

It focuses on postnatal MTCT with the following objectives

and uses a QI approach to boost existing country eMTCT

programs :

• Achieve universal breast feeding and improve nutrition

of mother-child pairs

• Ensure that all breast-fed infants exposed to HIV are

protected through ARVs

What are the overarching aims of the

Partnership?

Reduce transmission – post-natal period

When do

infants get

infected?

25% 15%What %

infants get

infected?

(unimpeded)

2% 10%How are we

doing (best

countries) Focus of the PHFS

Reduce transmission and improve

nutrition coverage

1%

15%

MTCT

>95%

??%Maternal

-infant

nutrition

Which countries are members of the

Partnership?• Six countries selected

and additional countries

welcome

• Project co-design

partners:

USAID

WHO

IHI

• Supporting existing

eMTCT and nutrition

plans

Four critical steps for mother-infant

care

Retain all mother-infant pairs

in care

Ensure mother-infant pairs

receive nutritional advice,

counseling and support

Know the HIV status of every

mother and infant

HIV -HIV +

Ensure optimal ARV

coverage for mother

and infant

Contents

▪ What is the Partnership for HIV-Free Survival?

▪ Quality improvement and the PHFS learning platform

▪ Early progress of countries

Gap between clinical trial and “real life”

PMTCT implementationPMTCT program performance in KZN

0

5

10

15

20

25

NVP 2007 AZT/HAART2008

AZT/HAART2012

clinical trials

"real life" implementation

Rollins N,. AIDS 21: 1341–1347 2007Horwood Bull World Health Organ. 2012 Mar 1;90(3):168-75, 2010Goga 2012

IMPLEMENT

PROBLEM

SOLUTION Traditional

model for

introducing

change

FAIL

SYSTEM BARRIERS

The traditional “top down approach”

GREAT IDEAS

SYSTEM ANALYSIS

IMPLEMENT

SUCCEED/SUSTAIN

SMALL TEST CYCLES THAT TAP LOCAL

KNOWLEDGE

PLAN

DO

STUDY

ACT

The “Gap”

Incorporating ideas from the front line

How is the Partnership going to reach

its goals?

0-9 months:

Phase 1

– pre-scale

up learning

phase

9-24 months:

Phase 2

– rapid scale

up phase

(Phase 3)

– scale up

across PHFS

countries and

SSA

Learning

session

2

PDSA

cycles

PDSA

cycles

Learning

session

3

Intensive QI support to facilities and managers

Country level Learning Collaboratives

18-24 months

Learning

session

1

Learning

session

2

PDSA

cycles

PDSA

cycles

Learning

session

3

Intensive QI support to facilities and managers

Multi-Country Learning Collaboratives

18-24 months

Learning

session

1

Contents

▪ What is the Partnership for HIV-Free Survival?

▪ Quality improvement and the PHFS learning platform

▪ Early progress of countries

Country Work to Date:

Kenya: 17 teams, QI Training, Coaching has

begun, Community engaged

Lesotho: 44 sites selected, 3 QI teams formed,

PHFS led by MoH, focusing on EBF (currently at

56%)

Mozambique: QI teams formed in 6 of 8 facilities.

Revising longitudinal Register. Integrating

indicators in the national QI Strategy. Engaging

M2M

Country Work to Date:

South Africa: Established PHFS steering committee and sub-committees at the national level; 33 facilities active. Two Learning Sessions held and data collected monthly

Tanzania: 33 facilities activated, baseline assessment completed, linked with Option B+, developing mHealth protocol to follow mothers

Uganda: 22 active sites; collected baseline retention data; held two learning sessions and a National Launch; highly engaged MoH, preliminary improvement in retention

18

MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) and implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University. Views expressed in this presentation do not necessarily reflect the views of USAID or the U.S. government. MEASURE Evaluation is the USAID Global Health Bureau's primary vehicle for supporting improvements in monitoring and evaluation in population, health and nutrition worldwide. The Institute for Healthcare Improvement (IHI) is funded through MEASURE Evaluation to support the Partnership for HIV-Free Survival (PHFS).