Improving care of HIV-infected breastfeeding

Transcription

1 Improving care of HIV-infected breastfeeding and their : Early results from the Partnership for HIV-free Survival Initiative in Uganda Tamara Nsubuga-Nyombi, URC IAS- Melbourne, Australia July 22nd, PHFS in Uganda 2 (ASSIST) Project 1

2 The Partnership for HIV-Free Survival Nutrition in 1 st 1000 days (optimal infant feeding, nutrition and health practices) Option B+ (effective ARVs to reduce HIV transmission) HIV-free survival of infants born to HIVinfected 3 Retention of mother-baby pairs in care 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Apr: Pairing of and Percentage of mother baby pairs retained in 22 PHFS sites vs 1 low volume HCIV and 1 high volume HCIV (April 2013 May 2014) % MB pairs retained in all 22 sites % MB pairs retained in one low volume site % MB pairs retained in one high volume site Apr 13 May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Changes May 13: Merged EID and ART services at one service points and gave same appointment date Jun 13: Peer involved in counseling on appointment keeping Sep 13: Assigned EID focal person to pair cards and make phone calls to Dec13: Set specific / separate day to see MB pairs At one low volume site ave. 93 pairs / mo May 13: Pairing of and Jun 13: Peers escort MB pairs to the clinic Jul 13: Family support group meetings used to identify MB pairs and see them then Nov 13: ART and EID merged so MB pairs receive services in one area Mar 14: Phone calls to At one high volume site ave. 170 pairs / mo 4 (ASSIST) Project 2

3 Mother-baby pairs who receive a standard package of care at routine visits 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percentage of mother baby pairs who receive a standard package of care at routine visits in 22 sites, June 2013 April 2014 Percentage at all 22 sites Percentage at one example site Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 Learning session 2; new client flow chart developed Merging of ART and EID services Expert clients trained to do MUAC and assigned responsibility of assessing and nutrition counselling Mothers told about what services to expect so they can remind HW if they forget a service Changes made at example site Number of mother baby pairs seen in all 22 clinics Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr clinics reporting 5 21 clinics reporting Integrating the content and process of providing care Content of care What is done: Guidelines on IYCF (e.g. all children should be exclusively breastfed for 6 months) Guidelines on Option B+ (all HIV positive should be initiated on B+) Process of care How it is done: Improve identification of and Improve retention in care Provide routine services Improve IYCF practices and adherence Output/ outcome HIV-positive on ART who are doing well Well nourished, HIV-free 6 (ASSIST) Project 3

4 Sequencing and simplifying the approach Completeness and accuracy of EMTCT data 95.4 % Work on bringing more and to care 1115 Every mother baby pair gets a standard package at routine visits 941 Monitor the status; initiate newly identified on ART % 2.9% Apr'13 May '14 39 Apr' 13 May '14 9 Jun '13 May '14 Apr '13 May '14 7 Collaborative improvement model (ASSIST) Project 4

5 Challenges and what we are learning Challenges: Not all HIV-positive at the different entry points are identified; need to improve linkages and PICT 2-3 of 15 HIV-positive do not consent to ART initiation immediately; health workers need to follow-up through phone calls What we are learning: Substantial effort has to be put into retaining and their in care for 18 months The QI approach enables health workers apply the most effective and efficient changes to improve their work Having more entry points, involving the community and merging ART and EID services improves ART coverage, retention and quality of care 9 Acknowledgements e The 22 PHFS demonstration sites The Ministry of Health, PEPFAR, and other partners in Uganda (TASO, JSI-SPRING, EGPAF-STAR SW) District quality improvement coaches Colleagues at USAID ASSIST For more information please contact: Dr. Humphrey Megere, Chief of Party, USAID ASSIST Project, URC Uganda hmegere@urc-chs.com (ASSIST) Project 5