HIV: Best practices lead to a practical guide for lowering mother-to-child transmission of HIV

The following is a guest post by Elizabeth Sutherland, PhD, of MEASURE Evaluation.

The Partnership for HIV-Free Survival was an innovative project designed to prevent mother-to-child transmission of HIV in six sub-Saharan African countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda.

An evaluation of these programs, conducted in 2018, revealed several best practices that the evaluators thought could easily be adapted in other countries in many contexts — with adaptations to suit the context. This evaluation was led by MEASURE Evaluation, funded by USAID and the United States President’s Emergency Plan for AIDS Relief. These agencies also funded the Partnership for HIV Free Survival, which operated from 2012 to 2016.

The differentiating factor of the partnership was that it brought together proven practices from  efforts to prevent mother to child HIV transmission: improvement of service quality and retention in antiretroviral therapy; nutrition assessment, counseling, and support; and community outreach initiatives to improve health and reduce HIV transmission for mothers living with HIV and their HIV-exposed infants. Following the evaluation of this successful program, MEASURE Evaluation published practical guidance on the evaluation and lessons learned and a checklist of practices that others might use to guide their own efforts to prevent mother-to-child HIV transmission.

Briefly, the chief lessons are:

• HIV-positive mothers and their infants should be seen together at clinic appointments.
• Ideally, mother-baby pairs should be seen at designated clinics.
• All necessary services should be provided during these clinic visits.
• Nutrition and breastfeeding support should be included in these visits.
• Facilities should foster quality improvement for their services and seek tools for practical ways to improve service quality.
• Frontline staff should have coaching and mentoring to sustain quality improvements.
• Staff should have ways to share experiences and lessons in improving PMTCT services—exchanging ideas with other facility staffs and with district and regional healthcare providers.
• Community workers, including peer mothers, are people who can be valuable assets for outreach to support mothers and their babies in HIV care and treatment.

A chief component to the effective implementation of these practices is attention to improvement in quality of service. The quality improvement practices used successfully in the Partnership for HIV Free Survival approach to preventing mother-to-child transmission of HIV were based on the Plan-Do-Study-Act cycle, which is proven and widely used globally.

To facilitate the implementation of that proven cycle at the facility level, the partnership used three tools and techniques: (1) quality improvement teams; (2) change ideas; and (3) quality improvement journals. These tools and techniques helped groups identify what should be improved and one or more steps to enact and then to examine the results and build on successes or adjust what did not work so well. The quality improvement journal was used to capture information about successes and failures.

Selected metrics and data sets to track and improve the performance and outcomes of programs to prevent transmission of HIV from mother to child are the essential core of the guide. Guide users may include health ministry directors or department heads, implementing partners, regional and district health officers, community organizations, and frontline health workers for program planning, advocacy, oversight and implementation.

For more information, read about MEASURE Evaluation’s work in maternal and child health and HIV and AIDS.