Cote d’Ivoire| HIV Care and Treatment-ART and PMTCT Spread Collaborative

Date improvement activities began: 
October, 2010

To improve the quality of services provided at health facilities providing ART treatment and PMTCT services. During this, the spread phase of the collaborative, the work will be extended from 41 demonstration sites to a total 120 sites and a focus will be to train the PEPFAR implementing partners (Aconda-VS-CI, EGPAF, HAI, ICAP).

Implementation package/interventions: 

During the demonstration phase of the HIV Care and Treatment-ART and PMTCT collaborative, QI teams tested and implemented a number of changes related to capacity building and processes redesign. Some specific changes included instituting periodic meetings for services providers on the importance of the completeness of files, creating PLWHIV community groups, training nurses to renew prescriptions, and reinforcing Information, Education and Communication (IEC) techniques for staff to use for HIV positive pregnant women during voluntary counseling and testing (VCT) sessions and at the time of delivery. Changes made regarding patient management included establishing registries to track patient files coming in and out of VCT archives, training directors in effective management of patient files, tracking patients who missed appointments through Community Health Agents (CHAs), establishing weekly or monthly lists of patients who were considered to be lost to follow-up, and creation of a notebook to be shared between the pre-natal consultation office and the delivery room in order to identify women who were HIV positive when they came in for delivery. Process modifications included taking patients’ weight and height in the reception area of the facility, calling patients who missed appointments, setting hours when services would be offered, creating maps to identify patients’ locations, engaging social workers to provide prescription renewals, and engaging vaccination personnel to identify infants who should be tested for HIV. This collection of best practices identified from the initial collaborative are now being spread to an additional 79 sites.


The key indicators tracked by teams in this collaborative include the following:
ART Indicators
• Percent of patients with all items filled in the medical record
• Percent of follow-up visits with CD4 test results recorded according to follow-up standards (M6, M12, M18, etc.)
• Percent of new records without the patient’s name listed on the front page
• Percent of HIV-positive patients who did the initial check-up visit
• Percent of eligible HIV-positive patients who initiated ART treatment
• Percent of scheduled appointments kept by HIV-positive patients
• Percent of HIV-positive patients lost to follow-up during ART treatment
• Percent of HIV-positive patients lost to follow-up before starting ART treatment
PMTCT Indicators
• Percent of clients with all items filled in the PMTCT medical record
• Percent of infants tested who had been born to HIV-positive women

Number of sites/coverage: 

This pilot collaborative was initially implemented at 41 sites in Cote d’Ivoire and it now being scaled up to an additional 79 sites for a total of 120 sites. This scale up includes 50 districts out of 83 in the country and 17 regions out of 19 regions. There are 3 University hospitals, 9 Regional hospitals, 33 General hospital and 71 medical centers participating in the collaborative work.


Starting in August 2010, coaching visits were conducted by national coaches who were trained by HCI staff to conduct coaching visits and facilitate learning sessions. The goals of the coaching visits are to provide technical assistance and QI direction to the QI teams.

Learning sessions & communication among teams: 

Two learning sessions have been held for the spread phase of the collaborative. Regional coaches facilitate learning the session with HCI staff but now are leading coaching visits alone. The learning sessions are an occasion for the QI teams to share their knowledge and their experiences with their counterparts and to learn about potential practices to put in place in order to improve their services.


Data reported thus far a show that at the PMTCT collaborative sites there has been an increase in the percentage of infants tested for HIV who were born to HIV-positive women. For spread sites this percent has increased from 50% in June 2010 to 67% in June 2011. At the ART site level, the percentage of patients with complete medical records has increased from 33% in June 2010 to 43% in June 2011. On all sites, the percentage of patients “lost to follow up” has decreased to, and remains under, 20% as reported in June 2011.


Report Author(s): 
Jean N’Guessan, Virginie Traore E., Boucar Maina, Alain Ackah, Youssouf Dosso, Victor Kouassi, Franck Kablan
HCI Project, Nat'l Program for HIV Care and Treatment (PNPEC) MOH-Cote d'Ivoire, Elizabeth Glaser Pediatric AIDS Foundation, UNICEF, Aconda-VS-CI, CARE, Int'l Center for AIDS Care and Treatment Programs, and Harvard School of Public Health AIDS Initiative
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