Tanzania | Lindi ART/PMTCT Collaborative

Date improvement activities began: 
November, 2009
Aims/objectives: 

To increase the quality of HIV/AIDS health care services, including PMTCT and ART services through building the capacity of regional and district teams and ART/PMTCT providers in modern QI methods to enable the redesign of essential ART/PMTCT care delivery processes.

Implementation package/interventions: 

Teams have conducted gap analyses to understand the challenges they were facing, conducted staff trainings, and modified recording processes. They have also begun dispensing cotrimoxazole at reproductive and child health centers, integrating ART services at RCH to address lost to follow up of newly identified HIV+ pregnant women , Collecting CD4 samples at Care and treatment units and send samples to laboratory than sending clients to laboratory, conducting patient follow-up in the community, and implementing periodic performance reviews.

Measurement: 

Teams track the following key indicators monthly: proportion of HIV-positive patients enrolled in CTC; proportion of HIV-positive patients screened for TB; proportion of HIV-exposed children under 18 months on cotrimoxazole; proportion of PLHA on ART with access to regular CD4 checks; proportion of HIV-exposed children enrolled at CTC receiving ART.

Spread strategy: 

The Lindi collaborative is notable because it represents the first partner spread collaborative in Tanzania, wherein the implementing partners—CHAI and EGPAF—spread and financed the interventions developed initially in Mtwara to a second region. The Clinton HIV/AIDS Foundation bears the running cost for the collaborative while HCI provides technical assistance during coaching and learning sessions.

Number of sites/coverage: 

This collaborative is active in 10 sites, including five district hospitals, two mission hospitals, and three health centers.

Coaching: 

The first coaching visits were conducted in February 2010 and emphasized strengthening skills and competence in QI teams. During May, 2011 coaching visits were conducted, reaching 63 participants in the collaborative. During August 2011 one coaching visit was made to all ten sites in the Lindi collaborative.

Learning sessions & communication among teams: 

The first learning session was held in January 2010. During July – September 2011, two learning sessions were conducted. Learning sessions are facilitated by HCI staff in partnership with the Regional Health Management Team.

Results: 

As of February 2011, the facilities reporting in the Lindi collaborative had achieved 100% of pregnant women testing positive for HIV being enrolled in care and treatment. The collaborative also reported at this time a lost to follow-up rate of 10%. Teams continue to make progress in improving the other indicators. As of August 2011, teams had increased HIV testing for exposed children from the previous August from 16% up to 65%. In this same time period teams increased the percentage of children (under 18 months of age) exposed to HIV who were receiving daily cotrimoxazole from 22% to 67%.

Best practices/conclusions: 

With the establishment of active quality improvement teams at facility level that meet monthly to review processes of service delivery and make necessary adjustments for improvement, it has resulted in improved outcome of service delivery. The integration of ART services at RCH has reduced lost to follow up of the newly identified HIV+ mothers; increased uptake of cotrimoxazole prophylaxis among HIV exposed infants and increased early HIV infant diagnosis.

 

Countries: 
Organization(s): 
Regional Health Management Team (RHMT), Council Health Management Team (CHMT), Clinton HIV/AIDS Initiative (CHAI), Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), GTZ
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