Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi

Laterra, Anne; Callahan, Tegan; Msiska, Thumbiko; Woelk, Godfrey; Chowdhary, Pari; Gullo, Sara; Mwale, Patience Mgoli; Modi, Surbhi; Chauwa, Felluna; Kayira, Dumbani; Kalua, Thokozani; Wako, Etobssie

doi:10.1186/s12913-020-05538-2

Cited by 7 publications

(11 citation statements)

References 26 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After applying QI solutions to identified quality-of-care challenges, we observed decreases in client wait time, reported stigma and VL result TAT, and increases in client satisfaction with wait time and service confidentiality. This highlights our system's effectiveness in improving HIV service quality at targeted facilities, echoing similar findings from other studies on the use of client-driven CQI models to address service quality gaps, such as the use of Community Score Cards to improve services to prevent perinatally acquired HIV in Malawi [19], use of electronic self-interviews integrated into rapid QI process to improve client−provider relationships in Eswatini [20] and use of CQI cycles to minimize service delays at HIV clinics in Kenya [9]. This service quality monitoring system also enabled IHAP-HK to more rapidly flag and deploy corrective measures to address service delivery and quality issues.…”

Section: Discussionsupporting

confidence: 76%

Facilitating person‐centred care: integrating an electronic client feedback tool into continuous quality improvement processes to deliver client‐responsive HIV services in the Democratic Republic of Congo

Tendo‐Bugondo,

Lieke,

Kasongo

et al. 2023

J Int AIDS Soc.

View full text Add to dashboard Cite

Introduction:Engaging communities in the design, implementation and monitoring of health services is critical for delivering high-quality, person-centred services that keep people living with HIV engaged in care. The USAID-funded Integrated HIV/AIDS Project in Haut-Katanga (IHAP-HK) integrated an electronic client feedback tool into continuous quality improvement (CQI) processes. We aimed to demonstrate this system's impact on identifying and improving critical quality-of-care gaps. Methods: Through stakeholder and empathy mapping, IHAP-HK co-designed a service quality monitoring system-comprising anonymous exit interviews and ongoing monitoring through CQI cycles-with people living with HIV, facility-based providers and other community stakeholders. IHAP-HK trained 30 peer educators to administer oral, 10-to 15-minute exit interviews with people living with HIV following clinic appointments, and record responses via the KoboToolbox application. IHAP-HK shared client feedback with facility CQI teams and peer educators; identified quality-of-care gaps; discussed remediation steps for inclusion in facility-level improvement plans; and monitored implementation of identified actions. IHAP-HK tested this system at eight high-volume facilities in Haut-Katanga province from May 2021 through September 2022. Results: Findings from 4917 interviews highlighted wait time, stigma, service confidentiality and viral load (VL) turnaround time as key issues. Solutions implemented included: (1) using peer educators to conduct preparatory tasks (pre-packaging and distributing refills; pulling client files) or escort clients to consultation rooms; (2) limiting personnel in consultation rooms during client appointments; (3) improving facility access cards; and (4) informing clients of VL results via telephone or home visits. Due to these actions, between initial (May 2021) and final interviews (September 2022), client satisfaction with wait times improved (76% to 100% reporting excellent or acceptable wait times); reported cases of stigma decreased (5% to 0%); service confidentiality improved (71% to 99%); and VL turnaround time decreased (45% to 2% informed of VL results 3 months after sample collection). Conclusions: Our results showed the feasibility and effectiveness of using an electronic client feedback tool embedded in CQI processes to collect client perspectives to improve service quality and advance client-responsive care in the Democratic Republic of Congo. IHAP-HK recommends further testing and expansion of this system to advance person-centred health services.

show abstract

Section: Discussionsupporting

confidence: 76%

Facilitating person‐centred care: integrating an electronic client feedback tool into continuous quality improvement processes to deliver client‐responsive HIV services in the Democratic Republic of Congo

Tendo‐Bugondo,

Lieke,

Kasongo

et al. 2023

J Int AIDS Soc.

View full text Add to dashboard Cite

show abstract

“…Participatory approaches ensure that the outcomes assessed are meaningful to the communities involved [ 16 ]. Examples of evaluations that actively engaged program participants were able to identify the indicators and changes that were important to the participants themselves [ 33 , 34 ]. Although the CaPSAI study is not using a participatory research methodology, the overlap between research and implementation went beyond just data collection.…”

Section: Discussionmentioning

confidence: 99%

Research and implementation interactions in a social accountability study: utilizing guidance for conducting process evaluations of complex interventions

Cordero

Mochache

Boydell

et al. 2022

Int J Equity Health

View full text Add to dashboard Cite

Background In recent years, researchers and evaluators have made efforts to identify and use appropriate and innovative research designs that account for the complexity in studying social accountability. The relationship between the researchers and those implementing the activities and how this impacts the study have received little attention. In this paper, we reflect on how we managed the relationship between researchers and implementers using the United Kingdom Medical Research Council (MRC) guidance on process evaluation of a complex intervention. Main body The MRC guidance focuses on three areas of interaction between researchers and stakeholders involved in developing and delivering the intervention: (i) working with program developers and implementers; (ii) communication of emerging findings between researchers/evaluators and implementers; and (iii) overlapping roles of the intervention and research/evaluation. We summarize how the recommendations for each of the three areas were operationalized in the Community and Provider driven Social Accountability Intervention (CaPSAI) Project and provide reflections based on experience. We co-developed various tools, including standard operating procedures, contact lists, and manuals. Activities such as training sessions, regular calls, and meetings were also conducted to enable a good working relationship between the different partners. Conclusions Studying social accountability requires the collaboration of multiple partners that need to be planned to ensure a good working relationship while safeguarding both the research and intervention implementation. The MRC guidance is a useful tool for making interaction issues explicit and establishing procedures. Planning procedures for dealing with research and implementers’ interactions could be more comprehensive and better adapted to social accountability interventions if both researchers and implementers are involved. There is a need for social accountability research to include clear statements explaining the nature and types of relationships between researchers and implementers involved in the intervention.

show abstract

“…This project adapted elements of the CSC approach originally aimed at broad-based community engagement to focus on engaging HCWs and clients of PMTCT clinical services to identify and solve PMTCT-related issues. The adaptation process and lessons learned are described elsewhere [19]. HCWs were…”

Section: Intervention Descriptionmentioning

confidence: 99%

Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi

et al. 2021

Self Cite

View full text Add to dashboard Cite

Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE’s) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) retention in PMTCT services, (2) uptake of early infant diagnosis (EID), (3) collective efficacy among clients, and (4) self-efficacy among health care workers (HCWs) in delivering quality services. The CSC is a participatory community approach. In this study, HCWs and PMTCT clients identified issues impacting PMTCT service quality and uptake and implemented actions for improvement. A mixed-methods, pre- and post-intervention design was used to evaluate the intervention. We abstracted routine clinical data on retention in PMTCT services for HIV-positive clients attending their first antenatal care visit and EID uptake for their infants for 8-month periods before and after implementation. To assess collective efficacy and self-efficacy, we administered questionnaires and conducted focus group discussions (FGDs) pre- and post-intervention with PMTCT clients recruited from CSC participants, and HCWs providing HIV care from facilities. Retention of HIV-positive women in PMTCT services at three and six months and EID uptake was not significantly different pre- and post-implementation. For the clients, the collective efficacy scale average improved significantly post-intervention, (p = 0.003). HCW self-efficacy scale average did not improve. Results from the FGDs highlighted a strengthened relationship between HCWs and PMTCT clients, with clients reporting increased satisfaction with services. However, the data indicated continued challenges with stigma and fear of disclosure. While CSC may foster mutual trust and respect between HCWs and PMTCT clients, we did not find it improved PMTCT retention or EID uptake within the short duration of the study period. More research is needed on ways to improve service quality and decrease stigmatized behaviors, such as HIV testing and treatment services, as well as the longer-term impacts of interventions like the CSC on clinical outcomes.

show abstract

Bringing women’s voices to PMTCT CARE: adapting CARE’s Community Score Card© to engage women living with HIV to build quality health systems in Malawi

Cited by 7 publications

References 26 publications

Facilitating person‐centred care: integrating an electronic client feedback tool into continuous quality improvement processes to deliver client‐responsive HIV services in the Democratic Republic of Congo

Facilitating person‐centred care: integrating an electronic client feedback tool into continuous quality improvement processes to deliver client‐responsive HIV services in the Democratic Republic of Congo

Research and implementation interactions in a social accountability study: utilizing guidance for conducting process evaluations of complex interventions

Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi

Contact Info

Product

Resources

About