Partnership for HIV-Free Survival-The Journal of the International Association of Providers of AIDS Care (JIAPAC)

The USAID ASSIST Project partnered with the Journal of the International Association of Providers of AIDS Care (JIAPAC) to publish a special supplement on the Partnership for HIV-Free Survival (PHFS), a six-country quality improvement initiative supported by USAID aimed at keeping positive pregnant and lactating women healthy and their exposed infants healthy, nourished, and HIV-free. The nine articles in the supplement, listed and downloadable below as PDFs, focus on the design of the partnership, the quality improvement approach used in all countries, learning and knowledge-sharing modalities, and key results, challenges, and accomplishments including increasing retention of mother-infant pairs and decreasing mother to child transmission in several countries. 

A 6-Country Collaborative Quality Improvement Initiative to Improve Nutrition and Decrease Mother-to-Child Transmission of HIV in Mother–Infant Pairs
Despite advances in coverage and quality of prevention of mother-to-child transmission (PMTCT) programs, infant protection from postnatal HIV infection remains an issue in high HIV-burdened countries. We designed a quality improvement (QI) intervention—the Partnership for HIV-Free Survival (PHFS)—to improve infant survival. PHFS convened leaders in 6 sub-Saharan African nations to discover together the best strategies for implementing and scaling up existing PMTCT protocols to ensure optimal health of mother–baby pairs and HIV-free infant survival.

Applying Quality Improvement Approaches to Reduce Mother-to-Child HIV Transmission and Improve Health and Nutrition Care in Five Countries: Lessons from the Partnership for HIV-Free Survival
The World Health Organization guidelines for treating pregnant HIV-positive women and preventing HIV transmission to infants now recommend lifelong antiretroviral treatment for pregnant and breastfeeding women. To address service gaps in 5 countries under the Partnership for HIV-Free Survival (PHFS) quality improvement (QI) methods were applied to support governments and facility staff.

Using a Multicountry Learning Network to Harvest and Rapidly Spread Implementation Knowledge across Programs Aimed to Reduce Mother-to-Child Transmission of HIV and Improve Nutrition: Perspectives and Lessons Learned for Similar Large-Scale Initiatives
As countries pursue UNAIDS’s 90-90-90 target for ending the AIDS epidemic, success is dependent on learning how to deliver effective care. This journal describes a learning network and mechanisms used to foster communication and sharing of ideas and results across 6 countries in the PHFS. The network used 2 forms of peer exchange, in-person and virtual, and a variety of knowledge management mechanisms to harvest and spread key learning. Key learning included valuable insights on how to design and convene a multicountry learning network, including top enablers of success and practical insights on the network’s value.

Reducing Mother-to-Child Transmission of HIV Using Quality Improvement Approaches
Over half of mother-to-child HIV transmission (MTCT) occurs postdelivery. Keeping mother–infant pairs in care remains challenging. Health workers in 3 countries used quality improvement (QI) approaches to improve data systems, mother–infant retention, and facility-based care delivery. The number and proportion of infants with known HIV status at time of discharge from early infant diagnosis programs increased in Tanzania and Uganda

Engagement of National Stakeholders and Communities on Health-Care Quality Improvement: Experience from the Implementation of the Partnership for HIV-Free Survival in Tanzania
The PHFS initiative in Tanzania integrated postnatal nutrition and mother-to-child transmission (MTCT) cascades to reduce vertical HIV transmission. Quality improvement (QI) was implemented in 30 health facilities. The collaborative QI approach improved process indicators for reducing MTCT in resource-constrained health systems.

Increasing HIV-Free Survival of Infants: Reorganizing Care Using Quality Improvement for the Optimal Health and Nutrition of HIV-Positive Women and Their Exposed Infants in Uganda
Reorganizing service delivery to integrate nutrition and infant and young child feeding (IYCF) with prevention of mother-to-child transmission (PMTCT) is important for improving outcomes of HIV-positive mothers and HIV-exposed infants (HEIs). Quality improvement (QI) strategies were implemented at 22 health facilities. T Using QI to integrate nutrition and ensure consistent and comprehensive PMTCT service delivery improved IYCF adherence and decreased transmission.

Applying Quality Improvement Strategies to Health Services for HIV-Affected Mother–Baby Pairs in Rural Kenya
The Partnership for HIV-Free Survival (PHFS) was piloted in rural Kenya using a quality improvement approach to integrate nutrition with prevention of mother-to-child transmission (PMTCT) of HIV services. Data were collected in a preintervention baseline (January 2013 to August 2013) and 3 periods during implementation (September 2013 to June 2016). Integration of nutrition assessment, counseling, and support (NACS) in PMTCT and retention of mother–baby pairs (MBPs) in care showed significant increase over time. The PHFS was successful in integrating NACS into PMTCT services and increasing retention of MBPs in care in Kenya.

Community-Based Improvements to Increase Identification of Pregnant Women and Promote Linkages to Antenatal and HIV Care in Mozambique
A Community Health System Strengthening model, which mobilizes communities by applying quality improvement, was used in 39 communities around 3 health centers in Gaza Province, Mozambique, to increase identification of pregnant women and support them to attend antenatal care (ANC). This article describes the process and results. Community group representatives formed a community improvement team to spread messages about the importance of ANC, identify pregnant women, link them to the facility, and follow up.


USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project/URC
ASSIST publication: 
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