The document summarizes a study on the effectiveness of a quality improvement collaborative (QIC) approach to accelerate the elimination of mother-to-child transmission of HIV (eMTCT) in South Africa. Key findings include:
1) The QIC approach achieved rapid improvements in eMTCT program outcomes such as increased early antenatal booking rates, HIV retesting rates, and postnatal visit rates.
2) Improvements were seen across different types and sizes of health facilities in the Eastern Cape province.
3) The success of the QIC approach was influenced by facilities' baseline performance, quality improvement skills training, leadership support, and organizational commitment to quality improvement.
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Implementing Transition - Ready Steady Go
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Transition to adult services - Gill Levitt
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Researching transition - Tim Rapley
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Researching transition - Tim Rapley
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NHS Improving Quality held an event in London on 31 July 2013 to progress the children and young people transition to adult services work with a focus on turning the rhetoric into practice entitled “Working to Define a Generic Service Specification for Transition”
Understanding how the Measurement and Monitoring of Safety Framework can form board understanding and help align strategic and operational approach to patient safety.
Full details: https://goo.gl/XyqTQA
Paul Bristow, BKPA, and Karen Thomas, UKRR gave a presentation at BRS2017: Embedding patient reported experience into future QI - 1st National PREM Pilot Survey 2016
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NHS Improving Quality held an event in London on 31 July 2013 to progress the children and young people transition to adult services work with a focus on turning the rhetoric into practice entitled “Working to Define a Generic Service Specification for Transition”
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Use of Secondary Data Analysis to Assess the Contribution of Nutrition to the...
Ntiyiso_S2S Academic Day Presentation_11 August_Final_ edits
1. Effectiveness of a quality improvement collaborative to
accelerate elimination of mother to child transmission:
Key outcomes and determinants, Eastern Cape Province, South Africa
Faculty of Medicine and health Sciences
Academic Day
2016 August 11
N. Shingwenyana1
, A. Chirowodza1
, D. Williams1
, C. Diergaardt1
, O. Adetokunboh1
, S. Gede2
, N.
Gobodo2
, N. Makeleni2
, N. Tuswa2
, B. Green1
, I. Oluwatimilehin1
(1)South to South Programme for Comprehensive Family HIV Care and Treatment, Department of Paediatrics and Child Health, Faculty of Medicine and Health
Sciences, Cape Town, South Africa, (2) Amathole District, Department of Health, East London, South Africa.
3. Background
• South Africa has made substantial improvements in
prevention of mother-to-child transmission (PMTCT)
• Reduction in vertical transmission from 8.2% 2008 to 5.8%
in 20091
and 3.5% in 2010 to 2.7% in 20112
in the recent
past, 1.2% in 20163
.
• Challenges remain in health programme implementation
for key antenatal and postnatal services.
• We to describe impact and determinants for successful
implementation of a quality improvement collaborative
(QIC) approach as a method to accelerate the
achievements of (eMTCT) goals in South Africa.
1
Sherman et al, 2010 2
Goga, Dinh, Jackson et al.; 2012,
3
Motsoaledi 2016
4. S2S Quality Improvement Collaborative
Pilot Phase: Jan 2013 to Dec
2013 - 4 Facility QI Teams in 4
Facilities
Demonstration Phase: Jan 2014 to Mar 2015 -
Maintain 4 QI Teams Established and Additional 10
Facility QI Teams
Learning
Session
1: ANC
Learning
Session
2: ANC
Learning
Session
3: DEL
Learning
Session
4: POST
Learning
Session
5: POST
Learning
Session 6:
Maint.
PDSA PDSA PDSA PDSA PDSA
Capacity building at Sub district, District, Province, Partners
QI COACHING, TRAININGS, PROGRAM TECHNICAL
SUPPORT
Stakeholder Engagement
and Ethics Clearance
5. Measure 1: 90 90 90 PMTCT Tracer Indicators
1. Antenatal 1st visit before 20 weeks rate
2. Antenatal client HIV re-test rate
3. ART Initiation rate
4. Mother postnatal visit within 6 days rate
5. Exclusive Breast Feeding rate
6. Infant 1st PCR test positive around 6 weeks rate
7. Child rapid HIV test around 18 months uptake rate
8. Child rapid HIV test around 18 months positive rate
9. Couple year protection rate
Methodology
6. • Measure 2: Quality Improvement Maturity
– 41 interviews conducted and Key Informant Focus
Group Discussions
• Sample (Different health system stakeholders)
– District/Sub district Managers
– Facility managers/Operational Managers
– Professional Nurses
– Data Capturers
– Lay Counsellors
Methodology
7. • Measure 3: Qualitative assessment
– Key informant interviews
• District Management Team Members
• QI Team Leaders
– Focus Group Discussion
• Quality improvement team members
Methodology
8. Data Processing
• Compiled control charts using selected PMTCT
indicators.
• Performed Wilcoxon signed-ranks test for
differences between pre- and post-
intervention medians.
• Descriptive analysis of quality improvement
maturity surveys.
• Thematic analysis of qualitative interviews
9. Results
• Improved performance in early booking rates (24 %; p<
.001).
• Improved antenatal HIV retest rates (31%; p< .001).
• Postnatal visit within 6 days rates improved (6%).
• Exclusive breastfeeding rates improved (28%; p< .001).
The 18 month rapid test uptake rates improved (28%;
p< 0.001).
• QI performance was influenced by baseline rates,
facility type and size, quality improvement skills,
leadership and buy in for quality improvement
11. Baseline versus post learning session median rates for PMTCT
cascade indicators amongst S2S supported sites in the Eastern
Cape 2012 - 2015
*p<001 for difference between median rates for baseline vs post learning using Wilcoxon Signed-Ranks Test
12. Organisational Quality Improvement Maturity
Scores amongst participating sites
High scores indicated role QI
readiness and buy in for QI as
important dimensions for success
High scores for QI Methods and skills
indicated role importance of training
in QI as important to success
13. Feedback about S2S support
Improved Knowledge of Data for
Programme Monitoring
“They helped me track whether I’m going to
meet our monthly targets. I never worried
myself about that graph until S2S came,
but now I can interpret that graph…for
instance, when I realised that I’m not going
to achieve my target, I decided to do an
internal campaign” Focus Group Discussion, QI Team
Member, EC.
14. Feedback: S2S Learning Network
Shared Learning
“I attended the first Learning Session. I was
surprised. I did not believe that what they
presented was achieved as shown in the data
in such a short space. I was so surprised at
how facilities were able to present as a group
what they had achieved together”.
DMT Member, NC
15. Feedback: S2S QI Tools
Problem Solving using QI Tools to Reduce Waiting Times
“We did that fishbone and PDSA….our facility is
normally full come 2 o’clock and the lines are still long.
S2S saw this so they wanted to reduce waiting times…
we had to section like those on chronic; they made
cards for us. If someone is going to the chronic side you
give them a particular number and those going to ANC;
ART….to avoid that mish mash…we developed a
strategy which saw other nurses coming in earlier so by
the time the others arrive the influx of people would be
reduced”
QI Team Member, EC
16. Conclusions
• The collaborative approach achieved rapid
improvements in eMTCT program outcomes.
• Improvements observed in a wide range of
contexts across facilities in the Eastern Cape
Province.
• Performance variability may be attributed to
contextual, organizational and system factors.
Editor's Notes
Previous slide shows snapshot before and after.
We have also conducted 54 statistical process analysis on all demonstration phase facilities to understand performance over time.
This figure shows 6 examples.
Allows
Monitoring of performance over time
Differentiation between special cause and common cause
Assessing effectiveness to changes. They are essential to show continues quality improvements. Most charts are showing stability in the process---, indicating system changes and possibility for sustainability of performance.
Moments when learning session show special causes are happening in the process.
Antenatal 1st visit before 20 weeks rates
Pregnancy screening for all women of child-bearing age
Health education talks provided in waiting rooms
Reduce waiting times to encourage health-seeking behaviour
Community care workers encouraging early antenatal booking
Fast-track pregnant women in waiting room
Antenatal client HIV re-test rate
Use of Antenatal Register to screen for missed appointments and notify community care workers
Community care workers do active tracing of women due for 32-week re-resting
Routine testing of all pregnancy women, irrespective of gestational age
