Transitioning to the WHO 2010 PMTCT and infant feeding guidelines at the local level: Identifying and addressing operational challenges in Tanzania
In August 2011, the USAID Health Care Improvement Project (HCI) in collaboration with Iringa Regional and Njombe District Health Management Teams conducted an assessment at three facilities transitioning to the 2010 guidelines in Njombe, Tanzania. Quality improvement methods were applied to identify and address operational setbacks and other transitional challenges.
Only 5%(5/91) of providers received training on the updated guidelines, which was inadequate for optimal service delivery. Late booking at antenatal care (ANC)beyond 14 weeks gestationdelayed timely initiation of antiretrovirals (ARVs) as recommended in 2010 guidelines. Earlier ARV initiation led to more women qualifying for ARVs. Additional drug cabinets and supply management trainings were necessary to meet the increased demand. Mothers were confused about continuing breastfeeding after six months as opposed to six months of exclusive breastfeeding under the 2006 guidelines. Mothers were concerned about side effects when giving ARVs to exposed infants for the newly extended period.
The MOHSW should ensure registers, reporting forms, and providers are updated on the 2010 guidelines. Mobilize communities to support booking earlier at ANC, infant feeding, and adherence. Facility staff should use monthly data to identify gaps in services to improve care. Local solutions identified as best practices can guide transition in other districts and regions.
Learning Areas:Assessment of individual and community needs for health education
Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Discuss operational challenges of transitioning to the WHO 2010 PMTCT and infant feeding guidelines. Discuss local solutions for operational challenges. Describe lessons learned and best practices.
Keyword(s): HIV/AIDS, Challenges and Opportunities
Qualified on the content I am responsible for because: I have been supporting HIV activities under the USAID-funded Health Care Improvement Project (HCI) for almost three years. This includes conducting a multi-country assessment for the Global Fund to determine the feasibility of using a set of HIV quality criteria to strengthen countriesâ capacity to monitor and improve the quality of their HIV services. I currently provide technical support on HCI PMTCT activities in Tanzania, and a safe male circumcision activity in Uganda.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.