Abstract
Early infant diagnosis (EID) and rapid antiretroviral therapy (ART) initiation are lifesaving interventions for HIV-infected infants. In Cameroon and Zambia, EID coverage for HIV-exposed infants (HEIs) is suboptimal and the time to ART initiation for infants infected with HIV often exceeds national standards despite numerous policy and training initiatives. ICAP at Columbia University supported the Cameroon and Zambia Ministries of Health (MOHs) and local partners to implement quality improvement collaboratives (QICs) to improve EID coverage and ART initiation at 17 health facilities (HFs) in Cameroon (March 2016 to June 2017) and 15 HFs in Zambia (March 2017 to June 2018). In each country, MOH led project design and site selection. MOH and ICAP provided quality improvement training and monthly supportive supervision, which enabled HF teams to conduct root cause analyses, design and implement contextually appropriate interventions, conduct rapid tests of change, analyze monthly progress, and convene at quarterly learning sessions to compare performance and share best practices. In Cameroon, EID testing coverage improved from 57% (113/197 HEIs tested) during the 5-month baseline period to 80% (165/207) in the 5-month endline period. In Zambia, EID testing coverage improved from 77% (4,773/6,197) during the 12-month baseline period to 89% (2,144/2,420) during the 3-month endline period. In a comparison of the same baseline and endline periods, the return of positive test results to caregivers improved from 18% (36/196 caregivers notified) to 86% (182/211) in Cameroon and from 44% (94/214) to 79% (44/56) in Zambia. ART initiation improved from 44% (94/214 HIV-infected infants) to 80% (45/56) in Zambia; the numbers of HIV-infected infants in Cameroon were too small to detect meaningful differences. QICs improved coverage of timely EID and ART initiation in both countries. In addition to building quality improvement capacity and improving outcomes, the QICs resulted in a "change package" of successful initiatives that were disseminated within each country.
Highlights
Infant diagnosis (EID) and rapid antiretroviral therapy (ART) initiation are lifesaving interventions for HIV-infected infants
Since the release of the Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast Track declaration in 2015, the global community has worked to achieve HIV epidemic control by 2030 by ensuring that at least 95% of people living with HIV are aware of their status, 95% of those aware of their status are linked to antiretroviral therapy (ART), and 95% of those on ART have achieved viral suppression.[1,2]
All health facility (HF) participated throughout the QI collaborative (QIC) and all learning sessions included representatives from each HF
Summary
Infant diagnosis (EID) and rapid antiretroviral therapy (ART) initiation are lifesaving interventions for HIV-infected infants. Health systems must consistently and correctly identify and engage HIV-infected pregnant women, provide ART for those not already on treatment, and deliver a package of services to their HIV-exposed infants (HEIs). These early infant diagnosis (EID) interventions include maternal counseling, HIV testing before 8 weeks of age, rapid return of results to parents/caretakers and treating clinicians, and prompt ART initiation for HIV-infected infants. Résultats: Au Cameroun, la couverture des tests de diagnostique précoce est passée de 57% (113/197 EEVIH testés) au cours d’une période de 5 mois d’analyse situationnelle et mise en œuvre du projet à 80% (165/207) au cours de la période finale de 5 mois interventions des tests rapides de changement. L'initiation du TARV est passée de 44% (94/214 nourrissons infectés par le VIH) à 80% (45/56) en Zambie; le nombre des enfants infectés par le VIH au Cameroun était trop peu pour détecter des différences significatives
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