Evaluation of the effectiveness of a quality improvement intervention to support integration of maternal, child and HIV care in primary health care facilities in South Africa

Haskins, Lyn; Chiliza, Jessica; Barker, Pierre; Connolly, Catherine; Phakathi, Sifiso; Feeley, Alison; Horwood, Christiane

doi:10.1186/s12889-020-8397-2

Cited by 14 publications

(21 citation statements)

References 24 publications

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“…From a Brazilian public policy perspective, these results indicate primary care services' difficulty in identifying, linking, and retaining care for children exposed to HIV, problems also seen in other studies [ 10 , 23 , 26 , 35 , 36 , 60 – 63 ]. In Brazil, primary care services monitor all newborns within their geographic areas of coverage [ 64 ].…”

Section: Discussionsupporting

confidence: 64%

Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil

et al. 2022

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Background There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up. Methods This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. Results Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09–1.43), the mother’s self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03–1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26–1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02–1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12–1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24–1.52). Conclusion Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.

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Section: Discussionsupporting

confidence: 64%

Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil

et al. 2022

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“…In contrast, where staff were poorly organized and unsupported, services were poor despite structural integration [40]. A South African group developed a model for KwaZulu-Natal that provided capacity building and commodity monitoring with involvement of community members [41], while a quality improvement program for maternal, child and HIV care in South African primary health care facilities resulted in improved child services but no impact on HIV-FP integration [39]. A comparison of FP services in integrated and non-integrated clinics in Malawi and Tanzania found no adverse outcomes due to strain on facility or providers but noted strengthened FP commodity stocks likely due to HIV-related supply chains in integrated clinics [38].…”

Section: Discussionmentioning

confidence: 99%

“…'Dual method' usecondoms for HIV/STI prevention PLUS a longer-acting method for pregnancy preventionis the best course of action [34], but often condom use is emphasized as an alternative rather than adjunctive method. Lastly, at the facility level, numerous studies confirm that logistical obstacles including under-staffing, lack of space, vertical service silos and sub-optimal training remain major challenges [37][38][39][40][41][42][43][44][45].…”

Section: Introductionmentioning

confidence: 99%

Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

et al. 2020

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Background: When integrated with couples' voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-tochild transmission (PMTCT). Methods: In this observational study, we enrolled equal numbers of HIV concordant and discordant couples in four rural and four urban clinics, with two Catholic and two non-Catholic clinics in each area. Eligible couples were fertile, not already using a LARC method, and wished to limit or delay fertility for at least 2 years. We provided CVCT and fertility goal-based family planning counselling with the offer of LARC and conducted multivariate analysis of clinic, couple, and individual predictors of LARC uptake. Results: Of 1290 couples enrolled, 960 (74%) selected LARC: Jadelle 5-year implant (37%), Implanon 3-year implant (26%), or copper intrauterine device (IUD) (11%). Uptake was higher in non-Catholic clinics (85% vs. 63% in Catholic clinics, p < 0.0001), in urban clinics (82% vs. 67% in rural clinics, p < 0.0001), and in HIV concordant couples (79% vs. 70% of discordant couples, p = .0005). Religion of the couple was unrelated to clinic religious affiliation, and uptake was highest among Catholics (80%) and lowest among Protestants (70%) who were predominantly Pentecostal. In multivariable analysis, urban location and non-Catholic clinic affiliation, Catholic religion of woman or couple, younger age of men, lower educational level of both partners, non-use of condoms or injectable contraception at

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“… 9 These three services are the focus of this systematic literature review because of the importance of finding efficiencies in the provision of HIV services 10 , 11 and the integration of primary care, nutrition and HIV. 12 , 13 Our objective was to critically assess the current evidence from the literature on the ABC and TD-ABC costing results for HIV, primary care, and nutrition services in LMICs to assist governments and donors in making key funding decisions. While there are a plethora of costing techniques, ABC and TD-ABC show promise as more reliable forms of costing for these types of services, providing important information to enable government and other policymakers to make efficient, cost-effective decisions on how to allocate limited resources.…”

Section: Introductionmentioning

confidence: 99%

Activity-based costing for HIV, primary care and nutrition services in low- and middle-income countries: A systematic literature review and synthesis

Bowser

Sombrio

Coulibaly

et al. 2021

Journal of Global Health Economics and Policy

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BackgroundThis study is a systematic literature review of HIV, nutrition, and primary care activity-based costing (ABC) studies conducted in low-and middle-income countries. ABC studies are critical for understanding the quantities and unit costs of the activities and resources for specific cost functions. The results of ABC studies enable governments, funders, and policymakers to utilize costing results to make efficient, cost-effective decisions on how to allocate scarce resources. MethodsWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology for systematic literature reviews. Key search terms included: (1) activity-based costing and time-driven activity-based costing, (2) cost of services, (3) HIV interventions OR (4) primary health care. Terms were searched within article titles and abstracts in PubMed, EconLit, and Scopus. Results1,884 abstracts were screened and reduced to 57 articles using exclusion criteria. After a full text review, 16 articles were included in the final data synthesis. Findings were used to classify costs into relevant and common inputs for activity-based costing. All costs were converted to unit cost (cost per patient) and inflated to January 2020 USD. The largest unit cost across nutrition services was training (US$194.16 per patient, 34.6% of total unit cost). The largest unit cost for HIV was antiretroviral therapy (ART)

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Evaluation of the effectiveness of a quality improvement intervention to support integration of maternal, child and HIV care in primary health care facilities in South Africa

Cited by 14 publications

References 24 publications

Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil

Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil

Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

Activity-based costing for HIV, primary care and nutrition services in low- and middle-income countries: A systematic literature review and synthesis

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