Abstract
Introduction. Early infant diagnosis (EID) of human immunodeficiency virus (HIV) ensures prompt treatment and infant survival. In Kaabong Hospital, 20% of HIV exposed infants (HEIs) had access to HIV diagnosis by eight weeks. We aimed to improve EID of HIV by deoxyribonucleic acid-polymerase chain reaction (DNA-PCR) testing by eight weeks from 20 to 100% between June 2014 and November 2015. Method. In this quality improvement (QI) project, EID data was reviewed, gaps prioritized using theme matrix selection, root causes analyzed using fishbone tool, and improvement changes were selected using counter measures matrix but implemented using Plan-Do-Study-Act cycle. Root causes of low first DNA-PCR testing included maternal EID ignorance, absent lost mother-baby pairs (LMBP) tracking system, and no EID performance reviews. Health education, Continuous Medical Education (CMEs), and integration of laboratory and EID services were initial improvement changes used. Results. DNA-PCR testing increased from 20 to 100% between June 2014 and July 2015 and was sustained at 100% until February 2016. Two declines, 67% in September 2014 and 75% in June 2015, due to LMBP were addressed using expert clients and peer mothers, respectively. Conclusion. Formation of WIT, laboratory service integration at MBCP, and task shifting along EID cascade improved EID outcomes at 6 weeks.
Highlights
Infant diagnosis (EID) of human immunodeficiency virus (HIV) ensures prompt treatment and infant survival
Of eligible HIV exposed infants (HEIs) for first deoxyribonucleic acid-polymerase chain reaction (DNA-PCR) (6–8 weeks) testing, testing of HEIs improved from five out of 25 (20.0%) in June 2014 to nine out of 10 (90%) in July 2014 when Continuous Medical Education (CME) for healthcare workers and health education talks to caregivers on the importance of Early infant diagnosis (EID) and dry blood spot (DBS) sample collection were integrated at the MBCP
The initial decline in September 2014 was due to loss of mother-baby pairs in the community and this was addressed by use of expert clients to track lost mother-infant baby pairs in the community
Summary
Infant diagnosis (EID) of human immunodeficiency virus (HIV) ensures prompt treatment and infant survival. We aimed to improve EID of HIV by deoxyribonucleic acid-polymerase chain reaction (DNA-PCR) testing by eight weeks from 20 to 100% between June 2014 and November 2015. In this quality improvement (QI) project, EID data was reviewed, gaps prioritized using theme matrix selection, root causes analyzed using fishbone tool, and improvement changes were selected using counter measures matrix but implemented using Plan-Do-Study-Act cycle. Root causes of low first DNA-PCR testing included maternal EID ignorance, absent lost mother-baby pairs (LMBP) tracking system, and no EID performance reviews. Continuous Medical Education (CMEs), and integration of laboratory and EID services were initial improvement changes used. Uganda launched the first QI strategic framework in 2010 This was followed by establishment of QI committees at various levels of healthcare (national, regional, district, health subdistrict, hospitals and its departments, and health centers) [13]. Quality of healthcare is an important mediator between the six WHO building blocks of health systems strengthening (service delivery, health work force, health information, health financing, leadership and medical products, vaccines, and technologies) and health outcomes (effectiveness, efficiency, responsiveness, and social and financial risk protection) [13]
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