Improving care of HIV-infected breastfeeding mothers and their babies:

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1 Improving care of HIV-infected breastfeeding mothers and their babies: Early results from the Partnership for HIV-free Survival Initiative in Uganda Tamara Nsubuga-Nyombi, URC IAS- Melbourne, Australia July 22nd, 2014

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Improving care of HIV-infected breastfeeding mothers and their babies: Early results from the Partnership for HIV-free Survival Initiative in Uganda Tamara Nsubuga-Nyombi, URC IAS- Melbourne, Australia July 22nd, 2014. PHFS in Uganda. The Partnership for HIV-Free Survival. - PowerPoint PPT Presentation

Transcript of Improving care of HIV-infected breastfeeding mothers and their babies:

Page 1: Improving care of HIV-infected breastfeeding mothers and their babies:

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Improving care of HIV-infected breastfeeding mothers and their babies:

Early results from the Partnership for HIV-free Survival Initiative in Uganda

Tamara Nsubuga-Nyombi, URC

IAS- Melbourne, Australia July 22nd, 2014

Page 2: Improving care of HIV-infected breastfeeding mothers and their babies:

USAID Applying Science to Strengthen and Improve Systems

PHFS in Uganda

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Page 3: Improving care of HIV-infected breastfeeding mothers and their babies:

USAID Applying Science to Strengthen and Improve Systems

The Partnership for HIV-Free Survival

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Nutrition in 1st 1000 days (optimal infant feeding, nutrition and health practices)

Option B+ (effective ARVs to reduce HIV transmission)

HIV-free survival

of infants born to

HIV-infected mothers

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USAID Applying Science to Strengthen and Improve Systems

Retention of mother-baby pairs in care

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Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-140%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of mother-baby pairs retained in 22 PHFS sites vs 1 low volume HCIV and 1 high volume HCIV (April 2013- May 2014)

% MB pairs retained in all 22 sites % MB pairs retained in one low volume site % MB pairs retained in one high volume site

Apr: Pairing of mothers and babies

May 13: Merged EID and ART services at one service points and gave same appointment date

Jun 13: Peer mothers involved in counseling mothers on appointment keeping

May 13: Pairing of mothers and babies

Jun 13: Peers escort MB pairs to the clinic

Sep 13: Assigned EID focal person to pair cards and make phone calls to mothers

Dec13: Set specific / separate day to see MB pairs

Jul 13: Family support group meetings used to identify MB pairs and see them then

Nov 13: ART and EID merged so MB pairs receive services in one area

Mar 14: Phone calls to mothers

ChangesAt one low volume site ave. 93 pairs / mo

At one high volume site ave. 170 pairs / mo

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USAID Applying Science to Strengthen and Improve Systems

Mother-baby pairs who receive a standard package of care at routine visits

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0%10%20%30%40%50%60%70%80%90%

100%

Percentage of mother-baby pairs who receive a standard package of care at routine visits in 22 sites, June 2013 - April 2014

Percentage at all 22 sites Percentage at one example site

0

500

1000

1500

309

1105

Number of mother-baby pairs seen in all 22 clinicsNumber of mother-baby pairs seen in all 22 clinics

Learning session 2; new client flow chart developed

Merging of ART and EID services

Expert clients trained to do MUAC and assigned responsibility of assessing and nutrition counselling

Mothers told about what services to expect so they can remind HW if they forget a service

Changes made at example site

20 clinics reporting

21 clinics reporting

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USAID Applying Science to Strengthen and Improve Systems

Integrating the content and process of providing care

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Content of care

What is done:

Guidelines on IYCF (e.g. all children should be exclusively breastfed for 6 months)

Guidelines on Option B+ (all HIV positive mothers should be initiated on B+)

Process of care

How it is done: • Improve

identification of mothers and babies

• Improve retention in care

• Provide routine services

• Improve IYCF practices and adherence

Output/ outcome

HIV-positive mothers on ART who are doing well

Well nourished, HIV-free babies

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USAID Applying Science to Strengthen and Improve Systems

Sequencing and simplifying the approach

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Completeness and accuracy

of EMTCT data

Work on bringing more mothers and

babies to care

Every mother –baby pair gets a

standard package at

routine visits

Monitor the babies’ status; initiate newly identified mothers on

ART

Jun '13 May '14

9

941

Apr' 13 May '14

39

1115

Apr '13 May '14

12 11

29

13

Apr'13 May '14

2.9%

95.4%

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USAID Applying Science to Strengthen and Improve Systems

Basics of Collaborative Improvement

QI team

site

Site-level summaryQI team

LearningSession

representative

Site-level testing of changes and analysis of results

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QI team

site

QI team

site

QI team

site

QI team

site

QI team

siteQI team

site

QI team

site

Collaborative-level sharing and synthesis of best practices

QI team

site

QI team

site

Multiple sites simultaneously testing changes, common indicators, peer learning about how to improve that area of care

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USAID Applying Science to Strengthen and Improve Systems

Collaborative improvement model

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USAID Applying Science to Strengthen and Improve Systems

Challenges and what we are learning

Challenges:

• Not all HIV-positive mothers at the different entry points are identified; need to improve linkages and PICT

• 2-3 of 15 HIV-positive mothers do not consent to ART initiation immediately; health workers need to follow-up through phone calls

What we are learning:

• Substantial effort has to be put into retaining mothers and their babies in care for 18 months

• The QI approach enables health workers apply the most effective and efficient changes to improve their work

• Having more entry points, involving the community and merging ART and EID services improves ART coverage, retention and quality of care

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Acknowledgements

The 22 PHFS demonstration sites

The Ministry of Health, PEPFAR, and other partners in Uganda (TASO, JSI-SPRING, EGPAF-STAR SW)

District quality improvement coaches

Colleagues at USAID ASSIST

For more information please contact: Dr. Humphrey Megere, Chief of Party, USAID ASSIST Project, URC Uganda

[email protected]

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