PMID- 21085479
OWN - NLM
STAT- MEDLINE
DCOM- 20110427
LR  - 20220409
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 5
IP  - 11
DP  - 2010 Nov 9
TI  - Improving a mother to child HIV transmission programme through health system 
      redesign: quality improvement, protocol adjustment and resource addition.
PG  - e13891
LID - 10.1371/journal.pone.0013891 [doi]
LID - e13891
AB  - BACKGROUND: Health systems that deliver prevention of mother to child 
      transmission (PMTCT) services in low and middle income countries continue to 
      underperform, resulting in thousands of unnecessary HIV infections of newborns 
      each year. We used a combination of approaches to health systems strengthening to 
      reduce transmission of HIV from mother to infant in a multi-facility public 
      health system in South Africa. METHODOLOGY/PRINCIPAL FINDINGS: All primary care 
      sites and specialized birthing centers in a resource constrained sub-district of 
      Cape Metro District, South Africa, were enrolled in a quality improvement (QI) 
      programme. All pregnant women receiving antenatal, intrapartum and postnatal 
      infant care in the sub-district between January 2006 and March 2009 were included 
      in the intervention that had a prototype-innovation phase and a rapid spread 
      phase. System changes were introduced to help frontline healthcare workers to 
      identify and improve performance gaps at each step of the PMTCT pathway. 
      Improvement was facilitated and spread through the use of a Breakthrough Series 
      Collaborative that accelerated learning and the spread of successful changes. 
      Protocol changes and additional resources were introduced by provincial and 
      municipal government. The proportion of HIV-exposed infants testing positive 
      declined from 7.6% to 5%. Key intermediate PMTCT processes improved (antenatal 
      AZT increased from 74% to 86%, PMTCT clients on HAART at the time of labour 
      increased from 10% to 25%, intrapartum AZT increased from 43% to 84%, and 
      postnatal HIV testing from 79% to 95%) compared to baseline. 
      CONCLUSIONS/SIGNIFICANCE: System improvement methods, protocol changes and 
      addition/reallocation of resources contributed to improved PMTCT processes and 
      outcomes in a resource constrained setting. The intervention requires a clear 
      design, leadership buy-in, building local capacity to use systems improvement 
      methods, and a reliable data system. A systems improvement approach offers a much 
      needed approach to rapidly improve under-performing PMTCT implementation 
      programmes at scale in sub-Saharan Africa.
FAU - Youngleson, Michele S
AU  - Youngleson MS
AD  - Institute for Healthcare Improvement, Cambridge, Massachusetts, United States of 
      America.
FAU - Nkurunziza, Paul
AU  - Nkurunziza P
FAU - Jennings, Karen
AU  - Jennings K
FAU - Arendse, Juanita
AU  - Arendse J
FAU - Mate, Kedar S
AU  - Mate KS
FAU - Barker, Pierre
AU  - Barker P
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20101109
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Antiretroviral Therapy, Highly Active
MH  - Child
MH  - Female
MH  - HIV Infections/*prevention & control/transmission
MH  - HIV-1/drug effects
MH  - Health Resources/standards
MH  - Health Services Needs and Demand/standards
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Infectious Disease Transmission, Vertical/*prevention & control
MH  - Medical Assistance/organization & administration
MH  - Pregnancy
MH  - Pregnancy Complications, Infectious/*prevention & control/virology
MH  - Quality Improvement/standards
MH  - Regional Medical Programs/*standards
MH  - South Africa
PMC - PMC2976693
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2010/11/19 06:00
MHDA- 2011/04/28 06:00
PMCR- 2010/11/09
CRDT- 2010/11/19 06:00
PHST- 2010/05/29 00:00 [received]
PHST- 2010/09/17 00:00 [accepted]
PHST- 2010/11/19 06:00 [entrez]
PHST- 2010/11/19 06:00 [pubmed]
PHST- 2011/04/28 06:00 [medline]
PHST- 2010/11/09 00:00 [pmc-release]
AID - 10-PONE-RA-19355R1 [pii]
AID - 10.1371/journal.pone.0013891 [doi]
PST - epublish
SO  - PLoS One. 2010 Nov 9;5(11):e13891. doi: 10.1371/journal.pone.0013891.