Improving Uptake, Retention, and Quality of PMTCT Services along the Entire Continuum of Care: Evaluation Findings, Tested Changes, and Guidance from Tanzania
Tanzania’s Iringa Region, located in the southern highlands, has one of the country’s highest HIV prevalence rates at 9.1% among adults age 15-49. Among women who utilize antenatal care services in the Iringa region, 81% receive HIV testing and counseling and receive the results of their HIV test.
Starting in 2011, the USAID Health Care Improvement Project (HCI), funded by the United States Agency for International Development (USAID) and the US President’s Emergency Plan for AIDS Relief (PEPFAR), began working with the Tanzania MOHSW, EngenderHealth, TUNAJALI-Deloitte, and Regional and Council Health Management Teams (RHMTs and CHMTs) to support 11 facilities in the Iringa Region to improve prevention of mother-to-child transmission (PMTCT) services. Iringa was chosen because its high HIV prevalence meant high-volume PMTCT services which would allow the project to learn a lot in a short amount of time about improving PMTCT services. In 2012, this work transitioned to the USAID Applying Science to Strengthen and Improve Systems project (ASSIST), the follow-on to HCI.
Assuring Infants and Mothers Get All PMTCT Services (AIMGAPS) aimed to improve the uptake, retention, and the quality of care along the entire continuum of care; from the antenatal period, throughout the entire breastfeeding period, and until the HIV status of the exposed infant is definitively determined. PEPFAR knew there was high attrition in PMTCT services among mothers and babies after receiving HIV tests. PEPFAR wanted to find out what could be done through AIMGAPS to retain mothers and babies in care.
The objectives of this activity were to assist frontline health care providers in Iringa to:
- Determine the baseline uptake, retention, and attrition rates for PMTCT services;
- Determine factors contributing to poor quality PMTCT services;
- Apply the collaborative quality improvement (QI) approach to improve PMTCT service uptake through identification of attrition points and test changes to reduce the problem; and
- Use results to develop a package for regional and national scale-up.
This report describes the AIMGAPS intervention, which included the application of the Community Health System Strengthening model to leverage community resources and groups to strengthen linkages between facilities and communities. It presents the results from data collected on seven indicators of PMTCT service performance in February 2011, July 2012, and the final data collection in May 2014. It also presents the detailed change package for improving uptake, retention and quality of PMTCT services based on the experience of the 11 QI teams in the demonstration facilities in Tanzania.