Details:

Alternative Title:
J Acquir Immune Defic Syndr
Publisher's site:
http://dx.doi.org/10.1097/QAI.0b013e31824c0267
Personal Author:
Ciampa, Philip J. ; Tique, Jose ; Jumá, Nilton ; Sidat, Mohsin ; Moon, Troy D. ; ... More +
Ciampa, Philip J. ; Tique, Jose ; Jumá, Nilton ; Sidat, Mohsin ; Moon, Troy D. ; Rothman, Russell L. ; Vermund, Sten H. Less -
Description:
Objective

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.

Design

Before/after study.

Setting

Two district hospitals in rural Mozambique.

Participants

HIV-infected mother/HIV-exposed infant pairs (N=791).

Intervention

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.

Results

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).

Conclusions

Retention improved by 55% with a simple referral enhancement. Quality improvement efforts could help improve care in Mozambique and other low-resource countries.


Subject:
[+]
Adult
Article
Female
Health Services Administration
HIV
HIV Infections
Humans
Infant
Infant, Newborn
Medication Adherence
Patient Acceptance Of Health Care
Pregnancy
Prevention Of Mother To Child Transmission / Vertical Transmission
Quality Improvement
Rural Population
Quality Improvement

Source:
J Acquir Immune Defic Syndr. 60(2):e46-e52.
Series:
PEPFAR
Pubmed ID:
22622077
Pubmed Central ID:
PMC3587032
Document Type:
Journal Article
Funding:
D43 TW001035/TW/FIC NIH HHS/United States ; U2G PS000631/PS/NCHHSTP CDC HHS/United States ; D43TW001035/TW/FIC NIH HHS/United States ; U2GPS000631/PEPFAR/United States
D43 TW001035/TW/FIC NIH HHS/United States ; U2G PS000631/PS/NCHHSTP CDC HHS/United States ; D43TW001035/TW/FIC NIH HHS/United States ; U2GPS000631/PEPFAR/United States Less -
Place as Subject:
Mozambique
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:3b2c145e4cdba6ee0c1ffa29d35b3fafe00d0c9ef97fc3ed88d19987ba485f90
File Type:

Supporting Files

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