α4β7 integrin expressing CD4+ T cells preferentially traffic to gut-associated lymphoid tissues (GALT) and play a key role in HIV/SIV pathogenesis. The administration of an anti-α4β7 monoclonal antibody during acute infection protects macaques from transmission following repeated low-dose intra-vaginal challenges with SIVmac251. In treated animals that became infected the GALT was significantly protected and CD4+ T–cell numbers were maintained. Thus, targeting α4β7 reduces mucosal transmission of SIV in macaques.

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BackgroundIn response to health care challenges worldwide, extensive funding has been channeled to the world’s most vulnerable health systems. Funding alone is not sufficient to address the complex issues and challenges plaguing these health systems. To see lasting improvement in maternal and infant health outcomes in the developing world, a global commitment to the sharing of knowledge and resources through international partnerships is critical. But partnerships that merely introduce western medical techniques and protocols to low resource settings, without heeding the local contexts, are misguided and unsustainable. Forming partnerships with mutual respect, shared vision, and collaborative effort is needed to ensure that all parties, irrespective of whether they belong to resource rich or resource poor settings, learn from each other so that meaningful and sustained system strengthening can take place.MethodsIn this paper, we describe the partnership building model of an international NGO, Kybele, which is committed to achieving childbirth safety through sustained partnerships in low resource settings. The Kybele model adapts generic stages of successful partnerships documented in the literature to four principles relevant to Kybele’s work. A multiple-case study approach is used to demonstrate how the model is applied in different country settings.ResultsThe four principle of Kybele’s partnership model are robust drivers of successful partnerships in diverse country settings.ConclusionsMuch has been written about the need for multi-country partnerships to achieve sustainable outcomes in global health, but few papers in the literature describe how this has been achieved in practice. A strong champion, support and engagement of stakeholders, co-creation of solutions with partners, and involvement of partners in the delivery of solutions are all requirements for successful and sustained partnerships.

The drastic improvement in adherence to hand hygiene suggests the potential value of the joint use of QI and implementation science to promote the creation and application of contextually appropriate EBPs in low-resource settings. Our results also suggest that using an implementation framework such as the ISF could rapidly increase the uptake of other evidence-based interventions in low-resource settings.

Background Referral hospitals see a disproportionate number of maternal and neonatal deaths in low-income settings such in Ghana. In 2013, the maternal mortality ratio in Ghana was 380 per 10 0000 livebirths: in 2015, combined data from three large referral and teaching hospitals showed a rate of 895 maternal deaths per 100 000 livebirths. For these deaths to be reduced, staff capacity needs to be developed to routinely identify problems with service delivery processes, and data-driven approaches will be required. In this study, we describe implementation of a quality improvement programme at Ridge Regional Hospital in Accra, Ghana.Methods Between 2013 and 2015, Ridge Regional Hospital adopted a quality improvement programme in three stages. In the fi rst stage, two senior staff members were selected to serve as QI (quality improvement) leaders and received 4 days of training in Six Sigma methods. In the second stage, two frontline staff from each of the eight departments in obstetric and neonatology were appointed as clinical champions and received 1 day of training in the running of small improvement projects using Lean principles and the Plan-Do-Study-Act approach. In the third stage, two levels of improvement projects-interdepartmental, led by the QI leaders and departmental, led by the clinical champions-were launched.Findings Within 6 months of the introduction of the quality improvement programme, two systems projects and two departmental projects to address waiting time for emergency caesarean sections and hand hygiene in the neonatal intensive care unit had begun. The two department-level projects addressed the triage of sick mothers and cleaning and organising the neonatal intensive care unit to reduce errors. There was a four-fold reduction in the percentage of mothers needing emergency caesarean surgery with unacceptable waiting times, over 93% accuracy in identifi cation of the sickest mothers, and a 37% increase in hand hygiene compliance.Interpretation The multi-level approach taken for quality improvement programmes has had some success in this referral hospital in Ghana. Improvements cannot be achieved without the engagement of all staff across levels, but selected leaders also need the analytical capability to address complex system problems. Each level reinforces the other. The approach at Ridge Regional Hospital is being scaled-up to four other Ghanaian regional hospitals. Furthermore, a learning network is being created to share improvement solutions across the entire system. To engage front line staff in building these capacities, while also increasing capability to address system problems, a multi-tiered approach is needed.Funding Kybele and PATH.