System Level Integration of Mother-Baby Services to Eliminate Mother-to-Child Transmission of HIV: The Missing Link

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Introduction: Kenya is among the 22 countries that account for >90% of all new pediatric HIV infections globally. Within the Partnership for HIV-Free Survival (PHFS), we initiated an improvement collaborative in Kwale County to generate lessons that can be scaled up to accelerate the elimination of mother-to child transmission of HIV (EMTCT).

Methodology: Improvement efforts often focus on microsystem process changes based on identified gaps in clinical practices. However if EMTCT is to be achieved, it is recognized that integration of EMTCT services within the MNCH platform is required. Despite this, frontline facilities have been left to figure out how best to achieve said integration. In Kwale County, with system-level change in mind, we trained and established improvement teams in 16 high-volume facilities and provided routine coaching to test, implement, evaluate and refine changes for EMTCT. Nearly all improvement teams tested changes in micro-processes of care. However, one of the 16 facilities developed an innovative approach of integrating maternal, newborn and HIV care by recording positive mother during pregnancy up to 24 months after delivery into one register. After successful testing of the register, it was identified as a viable system tool for integration, and scaled to all implementing facilities.

Results: Retention rate significantly improved from 30% in September 2013 to 63% in January 2015 (Fisher’s exact p=0.005) among the eligible population in the 16 facilities. In the same period, HIV-exposed infants receiving nutrition services increased from 18% to 69%. All HIV-positive mothers are now getting ARTs up from 86% at project start.

Conclusion: Integration of EMTCT into the MNCH platform may significantly improve retention of HIV-positive mother-baby pairs. Integration should be supported at system level. Kwale County’s experience provides insights on how this can be achieved at county and possibly be scaled to national level.