Addressing poor retention of infants exposed to HIV: a quality improvement study in rural Mozambique
Published Date:Jun 1 2012
Source:J Acquir Immune Defic Syndr. 60(2):e46-e52.
Pubmed Central ID:PMC3587032
Funding:D43 TW001035/TW/FIC NIH HHS/United States
U2G PS000631/PS/NCHHSTP CDC HHS/United States
D43TW001035/TW/FIC NIH HHS/United States
Early infant diagnosis (EID) is the first step in HIV care, yet 75% of HIV-exposed infants born at two hospitals in Mozambique failed to access EID.
Two district hospitals in rural Mozambique.
HIV-infected mother/HIV-exposed infant pairs (N=791).
We planned two phases of improvement using quality improvement methods. In Phase 1, we enhanced referral by offering direct accompaniment of new mothers to the EID suite, increasing privacy, and opening a medical record for infants prior to post-partum discharge. In Phase 2, we added enhanced referral activity as an item on the maternity register to standardize the process of referral.
Main outcome measure(s)
The proportion of HIV-infected mothers who accessed EID for their infant <90 days of life.
We tracked mother/infant pairs from June 2009 to March 2011 (Phase 0: N=144; Phase 1: N=479; Phase 2: N=168), compared study measures for mother/infant pairs across intervention phases with chi-square, estimated time-to-EID by Kaplan-Meier, and determined the likelihood of EID by Cox regression after adjusting for likely barriers to follow-up. At baseline (phase 0), 25.7% of infants accessed EID <90 days. EID improved to 32.2% after Phase 1; only 17.3% received enhanced referral. After Phase 2, 61.9% received enhanced referral and 39.9% accessed EID, a significant three-phase improvement (p=0.007). In adjusted analysis, the likelihood of EID at any time was higher in the Phase 2 group vs. Phase 0 (aHR:1.68, 95%CI:1.19-2.37, p=0.003).
Retention improved by 55% with a simple referral enhancement. Quality improvement efforts could help improve care in Mozambique and other low-resource countries.
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