Eliminating MTCT at scale: A six country collaboration using performance improvement methods

Background: An ambitious goal has been set to eliminate MTCT in HIV high-burden countries. To achieve this goal, health systems will need to deliver complex eMTCT protocols at high levels of coverage. We describe a six-country learning network to apply those methods to test and rapidly scale-up highly effective eMTCT programmes. Methods: Ministries, funders, NGO partners, and multilateral organizations in six countries (Kenya, Lesotho, Mozambique, Tanzania, South Africa, and Uganda) are collaborating under the Partnership for HIV-Free Survival to rapidly improve programming for EMTCT, accounting for WHO recommendations, focusing on postnatal EMTCT pathways and maternal/child nutrition. The two-year intervention aims for a 90% reduction in HIV transmission through breast-feeding (15% to 1%) with a proportionate improvement in child survival. Using QI methods, partners will develop a scalable district-based model of highly reliable EMTCT in two districts. A cross-country learning platform will accelerate the spread of knowledge. By project end, each country will have the knowledge and capability to spread their context-adapted model nationally. Results: Country teams will work together to develop strategies to rapidly enhance eMTCT performance, and report on learnings and common metrics for three drivers of district-based improvement: effective leadership/management, effective client-centered care for HIV infected/exposed mother-child pairs, and capacity to sustainably use continuous improvement methods. Discussion: The six-country learning platform will be launched in South Africa in March 2013, followed by country-based performance improvement interventions. The learning from this collaboration will be quickly analyzed and disseminated to other countries through multiple mechanisms, and through a formal evaluation.