Online Program

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

Tuesday, November 5, 2013 : 9:15 a.m. - 9:30 a.m.

Nneka Mobbison-Etuk, MD, MBA, MPH, Institute for Healthcare Improvement, Cambridge, MA
Tim Quick, USAID, Washington, DC
Amie Heap, USAID, Washington, DC
Kavita Singh, PhD, Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
Nigel Rollins, World Health Organization, Geneva, Switzerland
Maureen Tshbalala, Institute for Healthcare Improvement, Cambridge, MA
Sarah Olver, Institute for Healthcare Improvement, Cambridge, MA
Benjamin Picillo, Institute for Healthcare Improvement, Cambridge, MA
Pierre Barker, MD, Institute for Healthcare Improvement, Cambridge, MA
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.

Learning Areas:

Program planning
Protection of the public in relation to communicable diseases including prevention or control
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe a six-country learning network and how to apply quality improvement methods to test and rapidly scale-up highly effective eMTCT programmes.

Keyword(s): HIV/AIDS, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been supporting IHI's work in global public health for almost six years. I helped developed the strategy for the EMTCT Collaborative being presented and have supported the project since it began.
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.